hi I'm Dr John Arlette we're going to do some ultrasound work while we're doing some filter treatments part of it we're going to show ultrasound guided injection we're going to look at when the product is exiting out of the canula to give us an idea of where it is and for you to see what it looks like when it's happening underneath the skin we'll do it with the the color mode on and we'll do with the color mode off so we'll see a distinct difference in terms of different areas where we're going to be able to see filler coming out and then afterwards we'll be looking at areas where we've placed filler uh in the skin in particular when we're looking at redraping the uh mandible and the jawline so that you can see the areas where we've put product so that we can then fine-tune our results knowing on where we expect to put it and where in fact the product winds up after we have injected it color mode so we can see the tip of our canula right here and I'm now going to inject some product you're going to see first of all a reverberation from the canula down at the bottom you're going to see product coming up because you see the expanding an aoic space from the filler product so it helps you understand where it's coming out sometimes we'll even see a little little bit of flow as the product comes out of the canula increase gain there we are so there's our product flowing out there we go so we're I'm going to inject a little bit along the zygomatic Arch just to give a little bit of redraping of course you can see that I'm aspirating before each injection I'll just have you come interior a little bit and then we'll look at at these areas afterwards to identify the placement of our product so that we'll see it's did it is it where we expected it to be is the amount that we anticipated to be in the area to give the correction that we're looking for so we're just going to inject here along the mandible so we've just gone in through the surface of the skin we'll run this up to the tip of the chin and then we'll slowly inject along here so it'll be um helpful for us to watch afterwards about how the product is displayed is it a long thin line or is it a number of small Alo quats or BBS I would suggest that that products that have a higher G Prime and greater cohesivity will be more likely to be like little BBS and that with a lower G Prime and lower concentration lower degree of cross-linking uh will be more likely to be a thin thread of product in the tissue as we're trying to just sort of sharpen up her mandible and so we're just running the product in and you will be able to see immediately that there is a change so I'm just going to rotate her so we can see the difference one side to the other can you see that as we've redraped the jawline how there's an indentation here that the jawline is straighter here than it is on this side it's more indented we'll work to correct that change on the other side okay so we can start to see product coming up here and so in this we're going to put in 05 CC's on each side so we can see how this has come up on this side as well I'm now going to add a little bit of product to her chin just to bring this down as we look at straightening out the jawline so we're going to put a little bit underneath the tip of the chin just to bring this down a bit we're going to put point two CC's on either side of the symphysis of the chin of the mandible in order to bring this down evenly and then the last little bit that we're going to do is we're going to put some underneath her masseter in this area and we'll take a look for this afterwards just clench for me so you can put this in from the angle of the jaw you can go up about a centimeter go down deep to the Bone aspirate and Katie we're putting in4 CC's on each side we've done six syringes of filler in a variety of areas looking to lift and redrape the skin produce some foundational changes and correct some Contour now looks let's now we're going to look at the product that we placed and to see how it appears underneath the skin once we look with the ultrasound so let's look here on the zygomatic Arch where we place product and here we can see we have filler it's right over top of the zyg freeze we can see it here as a anaco aliquat freeze we're going to move down a little bit onto the upper cheek where we plac product in the skin and here we can see our product freeze we can see our product just below the skin above the uh paraded which we can see just inferiorly freeze and color mode we can see our vascularity in this area we can get an idea how far up the proded can come and how it can be a little bit bit discontinuous but we can see our product is above the smaz and above the PED let's just go down to the masser we can see our pared posteriorly we can see our masser color mode and we can see our product here on the mandible at the base of the masser as an anaco collection we're just going to look along the mandible color mode so we can see our product here in the mid space above the mandible which we see as this White Band we see product which is along the mandible starting about here at the U laal fold we can see our product in place that it is as Alo quats rather than as simple bands or threads let's just check the other side now here we have along the mandible we can see the product as it's displayed it's not continuous it is a little bit broken up but it's very near the mandible let's just move along and just check what we put in the masser and here's our product posteriorly excellent during our our session today you've seen us use ultrasound to exam and filler coming out of the canula to see its placement within the tissue as it's coming out you've seen it with and without the color mode on to show that we are not inside a vessel you can see it during active treatment much like you would be doing in your clinic we've then looked at the product after it's been place to see the volume that's put in its distribution within the tissue the amount the location so that you can now use your ultrasound after treatment to look at your patients to document that the product is in the location that you wanted it to be in in order to accomplish the Improvement that you were looking for with your patient in addition we've looked at a number of anatomical structures so that we have a good idea of where the product it is how extends all the way from the angle of the jaw up to the um the psychomatic arch we've looked at when we've placed product within the Deep perform faosa to examine for the vessels being patent after our treatment so we've seen a lot of use of ultrasound not just treating complications but treating active treatment treating the results of treatment which then for you can translate into how you can dictate changes in your therapy your Technique and your approach to your patients to get the results you're looking for and to help them look their best
