This document provides information on aesthetic medicine procedures. It begins by defining aesthetic medicine as procedures that revise the appearance of bodily features considered normal. It then lists and describes non-invasive, minimally invasive and invasive aesthetic procedures. Examples of non-invasive procedures include chemical peels and lasers, while botulinum toxin injections and filler injections are minimally invasive. The document also discusses what constitutes beauty and lists specific areas of the face that can be treated with botulinum toxin, along with recommended injection sites and doses.

1. Aesthetic Medicine
REJUVENATE, RESTORE, REGENERATE
BY DR. ILANGOVAN M.D., A.B. Internal Medicine
REGEN AESTHETIC HEALTH

2. What is Aesthetic Medicine?
There is currently no internationally accepted definition of aesthetic practice, but
can be defined in the following ways:
● The UK Cosmetic Surgery Interspecialty Committee has defined cosmetic surgery as an area
of practice involving "Operations and other procedures that revise or change the appearance, colour,
texture, structure, or position of bodily features, which most would consider otherwise to be within
the broad range of 'normal' for that person".
● The American Board of Cosmetic Surgery has defined cosmetic surgery as "a subspeciality of
medicine and surgery that uniquely restricts itself to the enhancement of appearance through surgical
and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it,
or enhancing it beyond the average level toward some aesthetic ideal".

3. LIST A AESTHETIC PROCEDURES
List A procedures can be grouped into the
following:
● Noninvasive
● Minimally invasive
● Invasive
These are aesthetic treatments and
procedures that are supported by moderate
to high level of scientific evidence and/or
have local medical expert consensus that the
procedures are well-established and
acceptable.

4. Noninvasive Procedures:
1. Chemical peels
2. Lasers (medical)
3. Intense pulsed light
4. Radiofrequency, infrared and other devices, e.g., for
skin tightening procedures
5. Photodynamic/Photopneumatic therapy External
lipolysis (heat/ultrasound)

5. Minimally Invasive Procedures:
1. Botulinum toxin injection
2. Filler injection
3. Phlebectomy
4. Sclerotherapy
5. Thread lifts
6. Lasers (vascular lesions, skin
pigmentation, skin rejuvenation)

6. Invasive Procedures
● Abdominoplasty
● Blepharoplasty (including double
eyelid)
● Breast enhancement or reduction
● Brow lift
● Free fat grafting
● Hair transplantation
● Implants (excluding breast implants)
● Lasers (skin resurfacing)
● Liposuction
● Rhinoplasty
● Rhytidectomy (facelift)
● Dermabrasion (mechanical)

7. LIST B PROCEDURES
These are:
a. Mesotherapy
b. Carboxytherapy
c. Microneedling dermaroller
d. Skin whitening injections
e. Stem cell activator protein for skin rejuvenation
f. Negative pressure procedures (e.g., Vacustyler™)
g. Mechanized massage (e.g., Slidestyler™,
endermologie for cellulite treatment)
List B contains aesthetic treatments and
procedures that are currently regarded as having
low/very low level of evidence and/or being
neither well established nor acceptable
currently.

8. What is Beauty?
➔ Beauty can be considered a combination of qualities, such as shape, colour, or form, that
pleases the aesthetic senses, especially the sight. In actual fact it is very difficult to define. And
yet we know it when we see it..
➔ Geometrically the ideal "beautiful" face is feminine. Developmentally all human faces begin as
feminine - even if genetically male. The exposure to testosterone in puberty changes the face to
the male configuration.
➔ As such the female is considered the more attractive sex. And not just to men but to all humans
including children and infants.
➔ Beauty is strongly associated with facial 'averageness', 'symmetry' and sexual dimorphism (the
differences in appearance between males and females of the same species).
➔ Reportedly the most important factor, however, is symmetry because having a face which is
equal on both sides is a potent biological advert for good genes.

9. The female ‘ideal’ features a mixture of central baby-like features and
peripheral mature features:
● Large eyes
● Prominent cheekbones
● Thin arched eyebrows
● Small nose
● Small jaw and chin
● Full lips

10. The male ‘ideal’ of beauty is similar to that of female with subtle differences that
make him appear more intimidating and protective. Differences include:
● Prominent brow resulting in the appearance of deeper set eyes.
● Flatter narrower eyebrows.
● Eyes slightly less "wide open".
● Slightly longer and/or wider nose.
● Slightly thinner lips.
● Square/angled/larger jaws.

11. ➔ To add another layer of complexity, there are 3 basic ethnic variations in the 'ideal' including
Caucasian, Asian and African variations.
➔ So, to a significant extent beauty is genetic, but living a healthy lifestyle and practising good skin-care
will definitely increase 'attractiveness'.
➔ Beauty is essentially a component of health, which is why investing in your general health will
ultimately increase beauty.
➔ Aesthetic medicine helps those achieve their goal of obtaining beauty, as well as confidence and self
esteem.

12. Thank You

13. Botox
➔ Botulinum toxin type A (BTA) can be used for facial aesthetics.
➔ The 3 currently available BTA types include onabotulinumtoxinA
(Botox; Botox Cosmetic, Allergan, Irvine, CA), abobotulinumtoxinA
(Dysport; Ipsen, Ltd, Berkshire, UK), and incobotulinumtoxinA
(Xeomin; Merz Pharmaceuticals, Frankfurt, Germany).
➔ Clinical uses for treatment of dynamic lines of the forehead, brow,
glabella, lateral orbit, nose, and lips are presented
➔ Also as treatment of masseter hypertrophy, platysmal bands, and
improvements of the perioral region. Specific BTA injection sites
and suggested doses are presented:

14. Areas on the face to inject:

15. Transverse Forehead Rhytides
The goals of treating the forehead are to soften the appearance of dynamic rhytides
without giving an unnatural, unexpressive appearance and avoiding iatrogenic brow
ptosis.Treatment of the forehead is highly variable because of the anatomic variability
of the frontalis muscle and characteristics of each patient’s animation patterns.
Moreover, some patients exhibit several fine transverse rhytides, where others have
only 1 or 2 deep transverse creases. Patients are asked to forcefully elevate their brow
to assess the strength of frontalis contraction and the location of dynamic rhytides.
The frontalis is typically injected in 4 to 6 sites, with care taken to stay at least 1 to 2
cm above the supraorbital rim to avoid brow or eyelid ptosis.

16. Glabellar region
Muscle size, strength, and location can be estimated by asking the patient to frown
maximally. Any asymmetry in muscle strength or contractionshould be carefully
evaluated before injection.The authors typically inject in a 5-point V pattern, with 2
injection sites

17. Brow Lift
Crow’s feet are typically treated with 3 equal injections of 2 to 4 U of Botox Cosmetic
at each site (Fig. 4). These injections should be placed superficially (intradermal),
producing a visible bleb beneath the skin. The middle injection is placed in line with
the lateral canthus, and the remaining 2 injections are placed 8 to 10 mm above and
below this point. Total starting doses should range between 8 to 16 U and 12 to 16 U
of Botox Cosmetic per side in women and men, respectively.

18. Bunny Lines
Some patients will present with complaints of oblique nasal sidewall rhytides,
caused by hyperactivity of the transverse portion of the nasalis muscle. These
rhytides are commonly referred to as bunny lines, owing to the patient
appearance with maximal contraction of the nasalis muscle. The nasalis muscles
can effectively be treated by injection in each muscle belly or a single, central
injection. We prefer the 2-injection technique to soften the appearance of bunny
lines.

19. Lips
Lip injections should be kept medial to a vertical line dropped from the lateral nasal
ala to the upper lip vermillion. Small aliquots (1–2 U of Botox Cosmetic each, total
dose 4–6 U) are injected between 2 to 4 symmetric sites along the superior vermillion
border. The lower lip injections should similarly stay at least 1 cm medial to the oral
commissures and should mirror or bisect the upper lip injections.

20. Acne reg laser surgery

21. Sclerotherapy

22. Medical Hair Loss

23. Cellulite

24. Chemical Peels

25. Threads