filler是什么意思ler在线翻译读音例句

791

an,eppe(eds.),AdvancedAestheticRhinoplasty,

DOI10.1007/978-3-642-28053-5_54,Springer-VerlagBerlinHeidelberg2013

54

54.1Introduction

Thenonsurgicaltreatmentofthenose,ormedi-

calrhinoplasty,hasbecomeoneofthehigh-

lightedindicationsintheaesthetictreatmentof登快阁黄庭坚ppt

theface[1–6].Theabsenceofimportant

mechanicalconstraints(dynamicfacialrela-

tivelypooronthislevel)associatedwiththesta-

bilityofthesupportsofthenasalpyramid

(cartilageandbone)offertothefillers“apar-

ticularlyfavorablebed.”

Thedurationoffillingisthusmoreimportant

thanontheleveloftheotherareasoftheface.

Thesatisfactionofthepatientsisstrongly

llyreservedforthecorrectionsof

thesurgicalimperfectionspostsurgery,theindi-

cationsoftreatmentareverywidetoday.

Inverymanycases,itispossibletoofferthese

asfirstindicationofthetreatmentofnasalcos-

meticdisgraces,associatedornotwiththebotuli-

numtoxininjectionsintheeventofmuscle

hyperactivities(depressorseptinasimuscle,…).

Thesemeetingsoftreatmentcanmoreoverserve

astrue“morphingmedical”forpatientswhowill

medicaltechniquesarenotinanycaseconcurrent

withthesurgery.

Therhinoplastyremainsbeforeasawhole

highlysurgicalprocedure(Fig.54.1),butthe

intrusionofthefillersandbotulinumtoxinoblige

ustodifferentlyunderstandtheindicationsof

ectivesofthe

treatmentarisefromtheartisticanalysisofthe

nakednose:“noseandtheface.”

Thetreatmentismodifiedby:

einitsownunitandvolumesthatcor-

respondtonasalvolumetry

ewithinthefacethatreferences

towardsthetotalharmonyoftheface(inpar-

ticularcontactanglestothefaceandtheupper

lip)

temporarytreatmentofthelipandthe

chinwiththefillersrealizes,moreover,atrue

“medicalprofiloplasty”

54.2AnatomicalBasics

Anatomicalbasicsareessentialtounderstandthe

seatofthetreatmentandtounderstandthepos-

ingon

Filler,BotulinumToxin,

andRhinoplasty:TheMedical

RhinoplastyConcept

FrdricBracciniandAlessioRedaelli

ni,M.D.(*)

aInstitute,

25avenueJeanMdecin,06000Nice,France

CliniquedesHpitauxenORLetChirurgie

Cervico-Faciale,CHUT昼的拼音 imone,

Marseille,France

ChirurgieFaceetCou,ORL,

25AvenueJeanMdecin,06000Nice,France

e-mail:c*******************

li,M.D.

ViaDiVittorio24,20070Dresano,Milan,Italy

e-mail:m*******************

li

theaverageathirdoftheface,thenoseappearsas

ahollowtriangularpyramidofosteocartilaginous

structurewithatopcorrespondingtotherootof

thenoseandabasewheretheopeningsofthe

naresare.

Onthisosteocartilaginousframe(Fig.54.2)is

placedanenvelopewithperichondriumandperios-

teum,amuscularplane,ersto

eachindividualananatomicalfeaturedetermining

thebeautyandtheharmonyofaface.

ab

Fig.54.1(a,b)Surgicalresultforrhinoplasty

Fig.54.2Anatomicalsupports

79354Filler,BotulinumToxin,andRhinoplasty:TheMedicalRhinoplastyConcept

Thereis:

1.Afixedportion,formedbythefrontalnotch,

therisingbranchesofthejawbones,theclean

bones,thehighersidecartilages(triangular),

andtheseptum

eportion,correspondingessentiallyto

thelowersidecartilages(wing)butalsotothe

highersidecartilages(lowerportion)whichplay

ationship

betweenthefixedandmobileelementsofthe

noseisfundamentalintheaestheticanalysisand

themedico-surgicalprojectofarhinoplasty.

Theapplicationsthatarisefromtheseinterre-

lationshipsmakereferencetotheconceptsof

thusfunda-

mentalbeforecarryingouttreatmentofrhino-

plastybymedicalfillingisontheknowledgeof

thestructuresofthenasalframe.

Theskinthatisveryrichinsebaceousglandsin

particularcomparedtothecartilaginousnoseand

itsthicknessvariesinanimportantwayaccording

kensveryfineontopandtowards

thepointandisinparticularcomparedtotheweak

inthesegmentofthe

osseousframe,itbecomesadherentwiththesubja-

centplanesintheportionthatcorrespondstothe

herenceisespeciallyintimateon

thelobule,thewings,

cellularfabricunderthecutaneousareaislittle

developedandlowinoils,itformsaquiteclear

layeronlyonthelevelofthemobilenose.

Themuscles(Fig.

54.3),innervatedbythefacial

nerve,areconnectedbetweenthembytheSMAS

andaretheelevatormuscles,depressors,andcom-

oleisgen-

erallymodestapartfromthedepressorofthe

septum(sorseptinasi).Theyareperfectly

accessibletotheactionfrombotulinumtoxin.

Thedeepenvelopeconsistsofperichondrium

andperiostealfibersthatareinterconnectedand

solidarizedbetweenthemthecomponentsofthe

nasalpyramid.

54.3VesselsandNerves(Fig.54.4)

Thereisahighriskforvascularornerveinjuries,

dependingonthefillerinjection

Forthevascularization,itisveryrich,andves-

selsaresafesmallsizesontheleveloftheangular

scularizationisfromthe

arterialbranchesoftheinternalcarotidnetworks

(ophthalmicartery)andexternalcarotid(facial

artery).Theveinsdraintowardstheangularvein

essentiallybutalsotowardsthefacialvein.

Fig.54.3Musclesofthenose

Fig.54.4Vesselsofthenose

li

Fortheinnervation,thebranchingengines

comefromthefacialnerve,andthesensitive

branchesemanatefromthetrigeminalviathe

externalnasalnerve,fromtheinfraorbitalnerve,

andfromthenervenaso-lobulaire.

54.4Fillers

Theauthorsuseverymanyproductsoffillingsin

intoaccountthesmooth-

nessofthecutaneouscoating,itisnecessarythat

theproductinjectedbenefitaperfectbalance

betweenitshomogeneity,itspotentialofdiffusion

infilledspaces,and,ofcourse,itsharmlessness.

Theauthorsneverusepermanentfillers.

Amongthemanyfillersavailableonthe

marketcurrently,thechoice“wasgradually

tightened”onhyaluronicacid,whichcanbe

injectedinsafetyinalltheareas,atthesame

timeonthelevelofthefixednosebutalsoon

thelevelofthenasalpointwherethecutaneous

tensionisveryimportantandwherethetoler-

d-

uctmustcontributehighreticulationforastable

cessarytouseproductswhosetol-

eranceandsafetyare“absolutetoday”(e.g.,

XHA3*Filorga,Juvederm*Allergan,Teosyal*

Teoxane…).

54.5InjectionTechnique(Fig.54.5)

Ideally,theprocedureisperformedafterapplica-

,however,becar-

alpoint

isthemostsignificessarytodraw

upwellitsplanoftreatmentbeforebeginningthe

,thenasalcutaneoustensionin

particularonthelevelofthepointissuchthatif

toomanyinjectionsarecarriedout,theproduct

tendstobeextruded.

54.6ProceduresofTreatment

54.6.1FillingtheHump

Theneedleisintroducedwithanobliquenessof

45ldbythe

cessarywiththeinch

andtheindexoftheotherhandtocarryouta

pressureonthesidewallsofthecleanbonesto

a

b

c

Fig.54.5(a–c)Fillingprocedures(humpandtip)

79554Filler,BotulinumToxin,andRhinoplasty:TheMedicalRhinoplastyConcept

accidentaldiffusionoftheproductcangoupto

theleveloftheareaoftheringsandthevalley

sometimesnecessarytofillthenasofrontal

anglebyasideaccesstoperfectthetreatment

ofthisarea(injectiondorsumbysideaccess).

Oncetheproductisinjected,itissetupbya

carefulmassage.

54.6.2DefinitionoftheTip

Itisnecessarytoavoidmultiplyingtheinjection

wopointsofpenetrationarethus

keitpossibletodistributein

aradiatingmanneronthepoint,thewholeofthe

ssureoftheinjectionisessential

cedureshouldbeslowandprogres-

sivetoavoidinvolvingacutaneousproblemable

ntshouldnot“blanch”

theeffectofthefilling.

54.7TreatmentoftheColumella

andOpeningofthe

NasolabialAngle

Treatmentwithbotulinumtoxinisnotcarried

outinsametimeasuseofafiects

directlyin-depththeproductthatisdepositedin

contactwiththenasalspinetoopentheangle.

Thelinesofcolumellearethenbalancedmore

superficially.

BotulinumtoxinAthatcanbeusedfor

thesetreatmentsistheonlybotulinumtoxin

permittedforaestheticuseineachcountry,in

particular:

el/Vistabex/CosmeticBotox,derived

fromBotox,Allergan,

beinpacksof50or100Utobekeptinthe

refrigeratorbetween2and8.

re,approvedinEuropeforafew

months,distributedinEuropebyGalderma,

anddirectlyderivedfromDysport,

moderatelystrongerthanBotox;itisin125U

packsandmustbestoredinarefrigerator

between2and8.

Thedifferen假如的近义词 tpreparationsarenotinterchange-

able,andthespecificunitsarediverse,justlike

theiractioninthetissues.

54.8ObjectivesandDetails

ofInjections(Fig.

54.6)

Thesitestoinjectare:

ectionsof2.5UVistabelor5UAzzalure

ineachelevatormuscleoflipandnasalwing,

tangentiallytothenasalwing.

2.5UVistabexor10UAzzalureatthenasion

level.

3.5UVistabexor15UAzzalureatthelevelof

thenasalspinedividedintotwoplanes,the

firstinjectionmustbesubcutaneousandthe

otherdeeplyincontactwiththebone.

54.9Protocol

carryoutafirstprocedurewithoutover-correc-

ventof

needareinjectionortechnicalrefinementsis

a

b

Fig.54.6(a,b)Botulinumtoxininjection

li

ultisthenremarkablystable

on12–18monthsforthefillersandstablefor

4monthsforthebotulinumtoxineffect.

54.10Indications

Allrhinoplastiescannotbecarriedoutmedi-

cally!….Theindicationsrisefromtheartistic

analysisandtherealizationoftheproject,as

-processing

morphingcanmoreoveralsocarriedoutbefore

thetreatment.

Aftersurgicalrhinoplasty,alltheirregularities

(asymmetry,deviation…)canbefilledbyafiller.

Theindicationsofthesefillingsaresamewith

thatofthecartilaginousgrafts.

Infirstintention,“theprincipalindication”is

thecamouflageofosteocartilaginouskyphosis.

Thetreatmentofthepointandfillingsofthecon-

tactangleswiththeliporthefacegiveremark-

ableresults.

Thecontrolofmimicalfacialwrinklesusing

botulinumtoxinA(BTxA)ispresentlyawell-

knownprocess,eveninall“off-label”uses,butits

useatthelevelofthenasalmusclesismorerecent.

Thisnewtherapeutictargetpresentlyopensavery

wideapplicationareaand,relyingonthemore

generalconceptthatincludesfacialrejuvenation,

itrecentlyplanstheuseofsmalldosesofBTxA

ofbotulinumtoxininto

thenasalmusclescountsanapproachtobecon-

sideredcomplementarytothefiller.

54.11Contraindications

54.11.1Fillers

Thecontraindicationsrelatedtotheproductand

itstechnicalinformationinclude:

fpermanentfillerandfillerdifferent

thanhyaluronicacid.

tion,itisnecessarytorespectcontrain-

dicationsspecifictothehyaluronicacid(cuta-

neousinfectioninprogress,pregnancy…).

hnicalcontraindicationsandcosmetics.

nticoagulantsmustideallybestopped

beforethetreatment.

Thepsychologicaldimensionofthenasal

modifica《早发白帝城》李白 tionmustalwaysbetakenintoaccount.

Contraindicationsaredirectlyrelatedtothepsy-

chologicalandartisticanalysispre-therapeutic,

andincertaincases,onlythesurgerywillallow

anadaptedresult,inparticularinthereduction

rhinoplasty.

54.11.2BotulinumToxin

Contraindicationstotheuseofbotulinum

toxinareallergytothedrugandinfectionor

inflammationattheproposedinjectionsite(s).

Safetyforuseduringpregnancyorlactation

ore,itispru-

denttoavoidbotulinumtoxintherapyfor

electiveproceduresinwomenofchildbearing

ageuntilabsenceofpreg代表中秋节的诗句 nancyoradequate

vecontrain-

dicationsincludediseasesofneuromuscular

transmission,coagulopathy(includingthera-

peuticanticoagulation),andinabilityofthe

orecomplex

disorders,botulinumtoxintherapyshouldnot

beusedunlessaskilledinterdisciplinaryteam

andsophisticatedinstrumentationareavail-

abletoensurevaliddiagnosis,state-of-the-

arttreatment,

physicianadministeringthisdrugshouldbe

trainedinitsuseandqualifiedtomanageany

complications.

Conclusions

Medicalrhinoplastyisaminimalinvasivepro-

cedure,temporarywithimpressiveoutcomes

(Figs.

54.7,54.8,and54.9).Itisaremarkable

procedurewhichgivessurprisingresultswith

astabilityhigherthanthatofthetreatmentsof

irestechnical

trainingandanartisticapproachoftheindica-

tionsaswellasthesurgicalrhinoplasty.

79754Filler,BotulinumToxin,andRhinoplasty:TheMedicalRhinoplastyConcept

ab

Fig.54.7(a,b)Medicalrhinoplasty(humpfilling,tipdefinition,botulinumtoxinindepressorseptinasimuscle)

ab

Fig.54.8(a,b)Medicalrhinoplastyfordeviatednose(fillingtreatment)

ab

Fig.54.9(a,b)Medicalsecondaryrhinoplasty(treatmentofthehumpdefectbyfilling)

li

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