Hyaluronic Acid Fillers: Layers, Ligaments and Technique
A full physician workshop on hyaluronic acid fillers: what the gel does in the skin, facial layers and ligaments, cannula versus needle, and aftercare.
This is the full recording of a hyaluronic acid filler workshop held on 4 August 2026 at Dr. Sinan Akyürek’s clinic in Istanbul for a group of visiting physicians. The working language is English. The session runs from the theory of why a face ages through to live treatment, and the participants’ questions are left in where they were asked.
The first part covers what hyaluronic acid does in the skin, what cross-linking changes in the behaviour of a gel, and how the layers of the face — skin, fat pads, retaining ligaments and bone — shift over the years. The second part is hands-on: temple, cheekbone and jawline injections, the landmarks used at each point, aspiration and slow delivery, needle versus cannula, and why a small amount placed deep can do more than volume placed at the surface.
It is meant for physicians who already inject and want to follow another practitioner’s reasoning: why one point is chosen over another, where the limits of the technique are, and when a step is deliberately left undone because it does not fit the patient’s life. This is educational content for physicians, not medical advice; no treatment plan can be taken from a recording without an examination.
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Chapters
- 0:03
Meeting the room: specialties, experience and today's plan
The session opens with a short company introduction, after which Dr. Sinan Akyürek introduces himself, his clinic and his years in medical aesthetics. He asks the visiting physicians which fields they come from — dermatology, dentistry, family medicine — and how long they have been injecting. He also explains that two patients will be treated live during the workshop.
- 5:30
Why the face ages: collagen, bone and gravity
Dr. Sinan explains why hyaluronic acid is the starting point of filler work and how the body draws collagen and hyaluronic acid away from the skin to repair the joints. He then follows the ageing chain step by step: shrinking fat pads, changing bone shape, loosening retaining ligaments and the sagging that follows. He also notes what he tells a patient who would need surgery but does not want it.
- 10:35
Two gel forms: cross-linking, lift and softness
The chapter compares the two hyaluronic acid concentrations used in the workshop and what cross-linking changes in the way a gel behaves under the skin. Dr. Sinan describes where each form worked in his own practice and where it did not, including his experience with lip treatments. He also points out that patient expectations differ from country to country, which changes the choice of product and technique.
- 15:52
Needle choice, injection depth and the massage question
Dr. Sinan goes through the technical data of the gels, the needle gauges he uses and how depth changes the outcome: placed deep it lifts, placed superficially it only adds volume. A participant asks whether the area should be massaged after injection. He answers that he massages very little, because pressing on a fresh gel changes its shape and the lift is lost.
- 21:03
Planning the face: which point lifts which area
The discussion turns to what makes a result look natural: the amount injected and the point chosen, not the product on its own. Dr. Sinan then reads the first patient's face and sets his order of work — temples first, then zygoma, cheek support and the pre-auricular area, so that the under-eye hollow is addressed indirectly. He also shows how he explains the plan to the patient before starting.
- 26:43
Temple injection: landmarks, aspiration and slow delivery
The live part begins at the temple. Dr. Sinan shows how he finds the temporal crest, keeps the temporal artery under his finger, splits the volume between two points and injects slowly down on the bone. He explains why he aspirates and counts before injecting, and warns that aspiration can be falsely negative, which is why the speed of the injection matters.
- 32:00
Lifting the skin before injecting under the ligament
Dr. Sinan tells how he once trusted a cannula and it still failed him, and why he treats a cannula as a risk of its own rather than a safe option. He then shows the lifting technique: he lifts the skin by hand, keeps the target point in mind and places a small amount deep on the bone, like a support under the retaining ligament. He also states the amount he plans for each point and why he keeps it small.
- 37:09
Cheekbone and jawline: landmarks around the artery
Work continues on the zygomatic eminence and then moves along the jaw. Dr. Sinan names the landmarks he uses — the distance kept from the tragus, the front border of the masseter, the mandibular angle — and where the facial artery and nerve run in relation to them. He also explains why he switches to a cannula in this area and why a gel without lidocaine matters for patients who react to it.
- 42:55
Where to enter, how much, and when to stop
The closing part covers cannula entry from below, why that route is easier for the patient, and the fine retaining ligaments that tie the skin to the deeper tissues across the whole face. Dr. Sinan shows the change along the jawline and then explains why he is leaving the chin untouched: the patient works in a school and wants a result nobody notices. The chapter ends on fitting the plan to the patient's own life rather than to what is technically possible.
Questions & answers
- 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. 25:02
- 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. 25:20
- How we can avoid this?
- For that, I count to 10. Not too quick, slowly, then count to ten inside. Believing in my cannula and I was forcing the subcision. So the cannula failed me. Cannula is a risky thing. 31:53
- 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. 33:42
Terms in this workshop
- temporal
- The temple region. In this recording it covers the temporal crest Dr. Sinan palpates as a landmark, the temporal muscle that relaxes when the patient opens her mouth, and the temporal artery he keeps under his finger while injecting.
- jawline
- The outline of the lower jaw, from the chin back to the mandibular angle. In this workshop it is the area supported at the angle and along the mandible to sharpen the lower face.
- masseter
- The chewing muscle at the side of the jaw. Dr. Sinan asks the patient to bite so that the muscle contracts and its front border becomes visible as an injection landmark.
- retaining ligament
- The fibrous bands that hold the skin down to the bone. Dr. Sinan explains that they loosen as collagen is lost, and that lifting the skin and placing a small amount of filler underneath works like a support so the tissue does not drop straight back.
- cross-linking
- The linking of hyaluronic acid chains that slows down how fast the gel is broken down in the skin. In the recording it is described as what improves the durability of the gel and, depending on how it is balanced, whether the gel lifts or stays soft.
- aspiration
- Pulling back on the syringe before injecting to check whether the needle tip is inside a vessel. Dr. Sinan counts to ten while aspirating and points out that the result can be falsely negative, so slow injection still matters.
Full transcript
Transcribed automatically, reviewed by hand.
0:03 Meeting the room: specialties, experience and today's plan
0:03More than 20 years, so you may talk about the market also, because your markets are different from each other, so fashion.
0:14I want to talk about the cognitive ? procedures, if you have questions you can ask here.
0:24We will start with the corporate profile.
0:28It'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.
1:18Yeah, when we look at the operating locations, we have a global company, so we have located in different countries.
1:26Our sales distribution office is Bogota, Colombia, for Latin America.
1:32Also, our sales distribution office is in Istanbul, that's why we are making these workshops held here in Istanbul.
3:27We are very proud to work with you.
3:33Because I don't know Arabic, excuse me for that.
3:36And you don't know Turkish.
3:37So I'm Dr.
3:39Sinan Akyurek.
3:41I'm working here.
3:42This is my clinic.
3:44I've been in the medical aesthetic sector since 2004.
3:49I've been a doctor since 2004.
3:51And with this clinic we are having our fifth year.
3:55But before that I had another clinic at the upper side of Nişantaşı again.
4:01I 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.
4:15So, with Gloderm, our journey started.
4:19[ad]'s mother, she is forced here to come to have lip fillers.
4:24She 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.
4:34So, we are going to numb her with nerve blockage, then do the injection ?.
4:44I'm also curious about that too.
4:46So this is
4:54the first time I'm seeing this presentation so let's speak and we have dermatologists here, dentists and any other specification?
5:08Sorry?
5:09Family medicine.
5:10So everybody is in medical aesthetics right?
5:15So how much experience Do you have six
5:21years of experience and three years?
5:25So there's not a new start, right?
5:28So everybody has some experience here.
5:30 Why the face ages: collagen, bone and gravity
5:30All right, then.
5:31So you know that hyaluronic acid is our first need when,
5:38if you're speaking about the fillers, we are mostly speaking about hyaluronic acid fillers.
5:43And 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
6:06dense hyaluronic acid formation for all over the market no other brand has 30 milligram in one milliliter so when
6:19we 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.
6:42So 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.
7:05So 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.
7:20So replacing that is the best choice of anti-aging.
7:25So fillers, when we are in our 20s, nothing is visible seriously.
7:33But as we age and come to 30, 35, something happens to be visible.
7:39Our face goes down with gravity.
7:41The gravity pulls us constantly.
7:44And in daytime, we are 15 or 16 hours vertical.
7:49So it presses our temples, our cheeks.
7:53And also, because of that pressure, the fat pads under our skin shrinks.
8:00Also, the bones change the shape.
8:04As we work on the cadavers who died younger ?, the orbital socket is like a circle.
8:13But when we work on the cadavers who died at the 50s, 60s, it goes back down like a water drop going down.
8:24And also, the zygoma gets thinner and gets lower.
8:28So 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
9:52you 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
10:35 Two gel forms: cross-linking, lift and softness
10:35okay 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.
11:16The cross-linking amount is so well-balanced that with 30 milligrams form, you also can have lifting, but also you have a soft gel.
11:30It 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,
12:11if you compare with other brands.
12:13So it's a different type.
12:15So that's why we first tried 20L when it was 20 milligrams of filler.
12:25It's a softer gel.
12:26So we first tried it for the lips, as we are used to use fillers with 20 milligrams for lips.
12:35that 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.
13:10But 30L is like a joker.
13:13You can use it everywhere.
13:14You can use on the
13:19temples, zygoma, jawline you may use, maybe nasolabial folds.
13:26Also you can do some lips if you want to.
13:28And 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.
13:43You'll see that injecting.
13:46It's an interesting filler.
13:47So the volume loss is our serious first approach at anti-aging procedures.
13:53So 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.
14:09I'm
14:15not losing our time with these.
14:18So with cross-linking, as you know, we improve the durability of the gel in the skin.
14:25So, as
14:29we mentioned, with 20L, we have 20 milligrams of cross-linked hyaluronic acid.
14:36They tell that lip reshaping is done with 20Ls, but patient satisfaction is something else.
14:44Because in Turkey, when patients ask for lip filling, they say that I want the most natural lips ever, ever, forever stuff.
14:55stuff, but when you give the natural results, they are not satisfied with that.
14:59So they try to tell that I want full lips, but not looking ridiculous.
15:05So 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.
15:22So for lips, for example, I use 30L.
15:29Maybe in England, for example.
15:32So it's cultural.
15:33Maybe German people might like it, because European understanding is something else.
15:40But as we go to the Middle East, so we are all working in the Middle East area, people love to see bold results.
15:52 Needle choice, injection depth and the massage question
15:52And with 30L, as I said, it's like my joker.
15:55I 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
16:18are all the technical data about it so
16:25osmolarities 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.
17:03For example, when you use Korean brands, especially that DVS ? technology, that beading, you don't have that chance.
17:12You need to use 25-gauge, otherwise it tires ?.
17:25So 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.
17:42And
17:51these are all obtained by Turkish doctors.
17:59Nose filler,
18:03lips with 30.
18:16Again, lip and also asymmetry correction.
18:26Full face reshaping, both the upper and mid face and also jawline.
18:32lips, nose.
18:35Thank
18:41you.
18:43Anything you want to ask?
19:28you 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.
19:41So you don't need more.
19:43Am I right?
19:44Especially I'll ask you not to do massage at first because the gel is when you inject you'll understand what I mean.
19:52is 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.
20:05So when you inject and then after that press, you change the shape of the filler, then you lose the lifting.
20:14So especially when doing massage she said, but I don't do massage at all.
20:22I 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.
20:44Sorry?
20:47Yes.
20:48You'll see very well.
20:50For example, the first patient is a very heavy-faced lady.
20:53You'll see what happens.
21:03 Planning the face: which point lifts which area
21:03that 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?
21:29Amount and injection point.
21:32If you do one milliliter exactly on the same point, you get an unnatural result eventually.
21:39But the filler acts like standard hyaluronic acid, cross-linked hyaluronic acid filler.
21:46But the specs are, it's not hard to inject.
21:51it'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.
22:18I don't understand anything.
22:2015 days later, maybe 20 days later.
22:22But when we take a look at the photos before the injection, you see what happens.
22:37Of course.
22:39But that depends on you, doctor.
22:42That depends on what you do.
22:44Because the filler is a good filler.
22:46But if you do overcorrection, it's not about the filler.
22:58And also, 30
23:09mg means it will attract more water and it will give more volume.
23:16When you try the injections ?, you will see that you will use less product for having the same effect with the other when
23:28you compare with it.
23:29So serious ?, but she has normal aging properties.
23:35And she is skinny also.
23:36She's not skinny.
23:38Not skinny, but her face is.
23:41So when we look at the patient, we have jawline and sagginess on the skin especially.
23:49And as usual, we lose volume with the mid-face area and also temples.
23:56So 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.
24:23so 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.
24:58So then you have less Tyndall effect.
25:02Can you inject the temple then, this?
25:05Yeah, yeah.
25:06So when speaking about the retaining ligaments around the eye, I have three important retaining ligaments there.
25:15One is orbicular.
25:17One is zygomatic.
25:19The other is temporal.
25:20First, lifting the temporal and zygomatic lifts the orbital, then I point to under-eye, right?
25:34Then temporal, pre-auricular fascia is an important one.
25:41Also lifting the fascia will give us another lifting point, so that will be the best I would do.
26:17Okay.
26:18Now, I'm planning to do something like this for you.
26:21Previously, I did not inform the patient about what I will do.
26:25We will perform the procedure that we call lifting with facial fillings.
26:29In 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.
26:36But my main job is to fix them.
26:38There are bonds that hold your skin tight here.
26:40They are a little loose in your case, they are stiff below.
26:43 Temple injection: landmarks, aspiration and slow delivery
26:43I will fix them with my hands and place them as if I were placing a wedge ? under their fillings.
26:49When you look at it from the outside, it does not look strange, but it will be a nice correction.
26:55She had numbing cream on her face.
26:59Numbing 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
27:34when I'm injecting on the temple I go find the crest from the temporal crest then the orbital limb and
27:47palpate
27:50the softness here so just on the corner then Then I
27:59have to be careful about the temporal artery because we have a serious volume loss here and I'll inject one milliliter total injected here.
28:08So giving one milliliter of filler here would create serious headache.
28:16So I'll do two injections, half a milliliter here and half a milliliter.
28:21You know, MD codes, have you been watching?
28:25All right, so I'll inject according to the MD codes, T1 and T2.
28:36When opening the mouth, we are relaxing the temporal muscle here.
28:41And also it shows where to inject itself.
28:44So temporal muscle leaves the way.
28:46So I lift the skin.
28:50Also lift the retaining ligament here.
28:55Palpate again, go down to the bone,
29:00aspirate, then
29:08inject.
29:09Aspiration is really important here because sometimes you catch a vessel.
29:290.5 here, and
29:35one
29:38centimeter behind that.
29:40again
29:45aspirate temporal artery is under my finger I'm
29:52holding it which is good for the patient and me slow
30:10injection is the trick so I'm not forcing even if I'm in a vein or artery just
30:28a small correction I don't do a strong massage You can close your mouth.
30:34What I did here caused some pressure increase.
30:37Don't be afraid.
30:38It takes a few days and then it goes away.
30:40Especially when you eat something, you feel the fullness there.
30:44It took a day when it was done to me.
30:45Some patients say that it makes them uncomfortable for 3-4 days.
30:49It's nothing to be afraid of.
30:50After 3 days, it goes away by itself anyway.
30:53There is an interesting implant.
30:54The implant is also entering right now.
30:56Because we have one thing there.
30:59There is a muscle.
31:28It starts from the jaw and goes up all the way.
31:31It's like a band.
31:32So she's now feeling the pressure, the stretching, on her implant, dental implant.
31:40Do you want to sit?
31:43Regarding the safety of injection of your needle,
31:48doing aspirations are not making us safe ?, but there is false negative aspirations.
31:53How we can avoid this?
31:54For that, I count to 10.
32:00 Lifting the skin before injecting under the ligament
32:00Not too quick, slowly, then count to ten inside.
32:08Take a look at the needle hole there, he said.
32:12But that's what I had.
32:16Believing in my cannula and I was forcing the subcision.
32:21So the cannula failed me.
32:24Cannula is a risky thing.
32:25So sometimes when you force with the cannula...
32:34Again, I'm going on MD codes, Ck1 points, again on the bone.
32:42Then I'll go with the zygomatic eminence here.
32:49Then there's the infraorbital artery and nerve here.
32:56Just next to that, for the deep fat, I'll inject again on the bone.
33:09In total, it will be 0.1, 0.1, 0.1, 0.3, 0.3, and 0.2.
33:17It will make 0.8.
33:22But let's see what happens.
33:24Maybe she might have a little more volumization here.
33:28here, if I need that, I will go superficial with half a milliliter.
33:34Let's see after the lifting.
33:35You use the needle lifting?
33:41Sorry?
33:42You use the needle, and you say, can you look because you want to lift it?
33:45Yes.
33:46I'm going at the deep fat beds.
33:49And when injecting, I hold.
33:54I 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
34:10I put it here like a pillar like a support leave
34:21it as it is it was like the
34:27retaining 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
34:47me for my air conditioner it's broken I think I think we also call the,
34:54now you see, I have the filler here on the bone.
34:58I don't do much of a massage.
35:00Sometimes I just slightly push it upward.
35:03Not press over it, but just giving shape.
35:07All right?
35:08Again, I'm going to the bone.
35:13And
35:22here, this
35:26is the worst part for the patient.
35:28She hears the cracking noise now.
35:38Again, it's one of the most risky areas I'm injecting.
35:42Here I found an artery once.
35:45So I'm aspirating and counting to 10.
35:49I'm on the bone.
35:50I'm nearly inside the periosteum.
35:54So
35:56that gives me the courage to inject.
35:59otherwise so
36:07it's
36:140.3 lifting
36:17started 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.
36:55You
36:59see, when she smiles, everything goes up and her face is lifted.
37:03So, I'm doing the same thing to her.
37:09 Cheekbone and jawline: landmarks around the artery
37:09On the zygomatic eminence, so I will inject there, but first I'm lifting it because when I lift, can you see the zygomatic ligament?
37:20It goes up, so I go down, check,
37:28again, aspirates, and slowly, 0.
37:50My filler is here.
37:53When I lift, the skin moves there, so that's why you see the new hole there.
38:01But I inject it here.
38:04When you touch, you feel the filler here.
38:06here and now
38:18the most dangerous part again I lift a little enter down to the bone yes I felt the bone do the aspiration and 0.3
38:41yes
38:51Let's see what happens.
39:24The real volume will be here with 0.3 again.
39:28I will just support the area with 0.1, 0.1 and give the weight here.
39:34But first, I want to do the lifting again, even superficially.
39:49I am using the cannula.
39:51Now I am informing my patient, too, because it is her first time.
39:55She doesn't know what I am doing at the moment.
39:58But she is so confident.
40:00Yes, she is confident.
40:03Also, if there is zero pain.
40:08Canınız acıyor mu? ?
40:11Very lightly, she says.
40:14And the thing I like about Gloderm, again, it doesn't contain lidocaine in it.
40:22So there are patients who are allergic to lidocaine for themselves.
40:28Gloderm is the only option for me.
40:30so now I came back then went under the fat pad and I will do 0.3 here because
40:51of 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.
41:00I want her to contract the masseter muscle, to bite.
41:04This is the scar ?.
41:06This is the front end of masseter.
41:10Alright?
41:11Here's my zygoma.
41:17And from tragus, I keep one centimeter of distance.
41:23And
41:27here's the masseter venter.
41:30So this is the area where I will inject.
41:32right and also I
41:39can also do Jw2 here
41:44we have the facial artery and nerve yeah so I have to use the cannula that's about
42:13the 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 ?.
42:48When you press, when you inject here, it gives a better lifting.
42:55 Where to enter, how much, and when to stop
42:55And 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
43:39I won't force, for example, you see.
43:42I found the empty area there.
43:45So
43:47I start with the one milliliter.
43:50Again, 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.
44:03so 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
44:37I use a 25-gauge cannula, not a very thick one.
45:110.5 milliliter, then I again do
45:19a small massage and do the lifting, you see
45:30when I inject the Ck4 there's a serious volume like here so i should inject it i found the mandible angle
45:46enter with my needle i'm
46:06here yeah
46:12i'm gonna lift it
46:20So, the jawline is really improved.
46:25Actually, 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.
46:52She wants very natural, unrecognizable results, so I won't touch her chin because of that.
46:59You will have a very good result if you touch this.
47:03Not now.
47:03Not now.
47:06Because everybody is bringing their children to the registrations of the school.
47:13So, she has to stay strict, right?
47:18So, now...