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The purpose of this technique is to offer patients wishing a labial restoration without morphological changes a simple, fast, discreet, comfortable, adaptable and reversible method by combining the two compounds most used in aesthetic medicine, botulinum toxin and hyaluronic acid. The originality of this combination is based on their mixing in the same syringe and their injection with cannula through a paracommissural approach which makes it possible to treat the entire upper lip in a very homogeneous manner. Botulinum toxin diffuses directly into the underlying muscle layer; hyaluronic acid allows to unfold the damaged cutaneous fan. The useful reciprocal dose of the two products remains intuitive; for starting barcodes the dose of botulinum toxin will be 8-10 Speywood units (4 Allergan units), for those already marked at rest 10-20 Speywood units (4-8 Allergan units); the hyaluronic acid will be chosen according to the depth of the wrinkles. We present a series of 63 patients with an average age of 67 years with a result deemed positive in 79% of cases. The incidents reported are generally due to excessive doses of botulinum toxin which can lead to the classic incidents of fluid leaks in this location (6%). The expected efficacy of the treatment depends on that of the components used (four to six months) but prolonged results have been regularly observed (up to 18 months). All complementary resurfacing treatments have been discarded here since the aim pursued is that of a natural labial restoration allowing an immediate return to socio-professional activities., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The restoration of the philtrum is an often neglected aspect in the technique of labial lifting with a perinasal scar, or it is secondarily resorted to by simple injections of hyaluronic acid. We are not in favor of the classic continuous bull's horn scar because, on the one hand, we consider that most of the labial shortening is due to the nasal floor resection -the internal excursion of which determines the final result-, and on the other hand that the approximation of 2 skins of very different nature (columella and lip) may cause a visible scar. The base of the columella is particularly well vascularized by the anastomosis of branches derived from the external carotid artery via the superior labial artery and septal branches distributed from the internal carotid system. We therefore consider that this zone on each side of the base of the columella constitutes the vascular pivot of our "mustache flap" drawn according to the classic peri nasal incision: this flap is desepidermized and then totally elevated from the orbicularis muscle except for its internal part where it is simply discarded so as not to compromise its vascularity; it is then rotated at 90° and inserted into a tunnel fitted in the subcutaneous plane down to the red lip corresponding to the restoration of the 2 philtral crests. Thus, all of the superior labial deformations observed over time (elongation and convexity of the white lip, flattening of the philtrum are corrected in a long lasting manner. The intervention is carried out under local anesthesia and, if necessary, the other elements of aging (loss of volume of the red lip, vertical wrinkles, defect of pigmentation etc.) can be corrected without risk at the same time., (Copyright © 2019. Published by Elsevier Masson SAS.)

As they usually do not have any serious effect on health condition, cellulite phenomenons are not considered as potentially hazardous by general practitioners; unfortunately they involve almost all the feminine population after the forties and may really induce bad side effects either psychological or physical whatever the confusing origin of that cutaneous deformation: heredity, nutrition, circulatory and hormonal diseases etc. Trying to appreciate in a more scientific way this superficial skin disorder, we have developed a computerised questionnaire which can be combined with the finest upto date way of skin exploration, high frequency ultrasonography. It seems possible to consider now cellulite as the result of various disorders which can be separate into fibrotic or retentional phenomenons (surrounding superficial fat tissues) and the direct adipocyte reaction (adiposis). We hope to be able in the future to extend the treatment of cellulite beyond the limits of liposuction which seems until today the only way to bring some improvement to that phenomenon in spite of the very delicacy of the surgical approach.

Leprosy still remains a dreaded disease despite the possibilities of permanent cure, the efficacy of surgical corrections, and its forthcoming disappearance. The authors conducted several surgical missions in Benin-Africa--over 4 years and report an interesting rate of control in the survey of patients as the results of their procedures were reviewed in 84% of them. Leprosy represents the perfect example of the difficulties of any humanitarian involvement with apparent contradictions between the aims of the medical wishes and the presence of a dreaded symbol that--fortunately or not--allow the existence of the many associations involved in the fight against leprosy.

The liposuction with a rotary cannula combines suction under traditional depression with rotation of the cannula mounted on a hand-piece, connected to a motor. This rotation, which can be has high as 400 r.p.m., allows 360 degrees treatment of lipodystrophy in a single procedure. Safety is ensured by an adjustable couple limiter, which prevents any risk of accidental movements when the cannula meets resistance. The authors conducted a study on 2 cases, which demonstrated a definite advantage of this technique in marked to severe lipodystrophy (1.5 to 7 litres of suction) and in high-density zones which are difficult to treat (epigastrium, knees, dorsal folds). This technique does not provide any decisive advantages in cases of minor lipodystrophy, which could justify its routine use in this context.

Cervicofacial liposuction, a simple procedure with a rapid postoperative course, has become an essential technique in many facial "reconstruction" indications, for rejuvenation or morphological reconstruction objectives. It can be performed on an outpatient basis and complications are extremely rare. However, its results remain unpredictable, as they depend on secondary cutaneous retraction, an unpredictable individual factor. However, it is unable to resolve all situations and can be associated with various simple or complex procedures which clearly and reciprocally improve results. The author report his 10-year experience of cervicofacial liposuction.

The massive use of hypertonic solution in subcutaneous tissue inevitably causes a necrotic reaction whose severity is directly correlated to the extent of infiltration, involving, as in the present case, all of the abdomen and the anteromedial surface of the thighs. This infiltration was performed for ultrasound treatment as part of liposuction in which the cutaneous swelling must be particularly marked in order to obtain full benefit from this technique. The direct action of ultrasound itself cannot be incriminated in this case. The present case developed was abdominocrural necrosis requiring six weeks of hospitalisation, including twelve days in the intensive care unit and skin cover by split skin grafts after debridement. Although this complication is not specific to liposuction, the quantities of saline regularly infiltrated with this technique carry a high risk of this complication, for which the doctor is inevitable responsible, even if it is due to a confusion on the part of paramedical staff.

The naso-labial fold is a permanent depression of the face which corresponds to the combined action of congenital and acquired factors such as cutaneous atrophy, bone resorption, muscular activity and skin ptosis. It is therefore not realistic to abandon any attempt to correct this complaint or to provide a universal solution to correct it; over the last four years, we have used EPTFE implants to fill the naso-labial fold: triangular, in one or two layers introduced via a gingival incision for the upper naso-labial part, with 2 mm large strips directly inserted through the skin for the lower labio-mental part. Tolerance and versatility were always remarkable; efficacy depends on the possible associated cutaneous ptosis: if major, a lifting procedure, more or less extensive, must be offered, which may also improve the projection of the malar area with an implant of the same material introduced via an oral or temporal approach. All other well known procedures (liposuction, fat grafts, collagen, etc.) may be employed but only as a complement to filling and traction procedures.

E-PTFE soft tissue patch composed of a largely open space surrounded by PTFE fibers has been fibers used for many years in plastic surgery. Its softness, tolerance, adaptability lead us to a progressive use in esthetic surgery as a filling material for natural depressions of aging faces (forehead, cheeks, naso-labial folds) or as a projection material (supra-orbital arch, malar, chin). None of these implants were removed for injection or incompatibility and these results seem encouraging for an extensive esthetic use.