Hello, everybody. I'm Bonito Tom from Brazil, and we'll be both moderate and talking in this webinar. It's organized by the ESPS and the Brazilian Society. And the topic is cutting edge technique used for neck, nose, and heart implants. Please submit questions throughout the presentation using the chat feature. We will answer as many questions as possible at the end of the webinar. The topic of the webinar today will be the name, cutting edge technique used for neck, nose, and heart implants. We have rhinoplasty, of course. I'm going to talk about rhinoplasty. Dr. Marcello Araújo is going to talk about face rejuvenation. And Dr. Carlo Eduardo Guimarães Corrector are going to talk about beard restoration. Let's start with rhinoplasty. Seen in the meeting lately, a kind of polarization between structured rhinoplasty and preservation. And which is the best? Which one works perfectly? Some colleagues believe that structured rhinoplasty is a good one. Others think that preservation is the right technique to perform rhinoplasty. I think that both can be used depending on the patient. That's philosophy. That's the reason that I'm going to demonstrate throughout the presentation. Let's begin about some concepts and clarify some concepts. Approached rhinoplasty could be open or closed. Structured rhinoplasty is always open technique. Because the open technique, you undo all the elements to redo it again. You have to structure it to have good support. On the other hand, the closed technique could be preservation, semi-closed, or closed. I'm going to talk about one of each during the presentation. Let's make clear what structured rhinoplasty means. It's a technique that utilizes cartilage grafts to strengthen the nasal foundation. Now, let's ask the first question. It's possible to perform rhinoplasty with no grafts at all? Can we support the normal anatomy by preserving or transposing the adjacent tissue? The answer is yes. This can be achieved with closed approach. Closed approach, it could be preservation, semi-closed, or closed. There are many, many different closed approach. The secret is to find the ideal candidates that usually is young patients that have good cartilage, primary operation, don't try to do it secondary, and patients who presents good cartilage support. The preservation technique, the so-called preservation technique, is a technique that preserves the ligaments. And all the undermining should be under the pericondrial. Mainly the pituitary ligaments, that's a ligament that goes from below the skin, but it's mass, roof of the nose, to the abdominals, and the medial crust. This ligament should be preserved, and all the undermining should be pericondrial. What are the advantages of the closed technique, or closed techniques? It's less invasive, no scar, lesser edema, and lesser operative time. Now, how to select the best approach, open or closed? What are the criteria? My criteria is based on structural strength and chip support mechanism. You see this short video on the right side of the monitor. You can assess it by visualization and palpation. Palpation because if you press the tip of the nose toward the nasal spine and observe the resilience, the strength of the chip cartilage, this gives us a very good idea how good is this cartilage to perform rhinoplasty with no grafts at all. Based on this examination, we developed three types of grafts at all. You can use preservation or semi-closed. Type two, moderate support. You can use preservation or semi-closed. And finally, type three is poor support, usually secondary nose. So the extracted rhinoplasty is indicated for this kind of patient. I'm going to have some illustration about that. Now, it's recalls me a citation by Shakespeare, a rose by any other name would smell as sweet. It's just a name, deliver a semi-closed preservation. Actually, all these techniques are closed techniques that deliver the cartilage to perform the modification plant. Let's illustrate this with the first case. This patient presents a bulbous tip, wide dorsum, and small hump. It's classified as type two. And now I'm going to show you my version, my view of the closed technique that I call semi-closed. In the same way, you do the incision, just infracartilaginous, but it's supraperichondrial. And then you take the cephalic portion of this cartilage, you move both cartilage to the right nostril and create a tunnel from the top between the medial prura and insert the columella strata. That's enough to improve the strength of this medial crass, allowing to perform the tip refinement with transdomal suture, as you can see in this video. And that's all we do for this patient to present, to show that result four years old, presents columella strata, domus suture, wide, slight dorsum reduction, rasp, and osteotomy. You can observe that balance between tip and dorsum in a more aesthetic. Remains the tip that's the main concern of the patient, you can control with this closed technique. Now, one second illustration. This patient presented type one very good cartilage support. There's no need to do any grafts at all, just trimming the same technique I presented before without any grafts. You see the balance, tip-dorsal balance, and then basilar triangulation that is the idea of the patient. Now, you can see one patient that presents more particular, I'd say, flaws. That's a lower lateral cross verticalization in a small hump. This patient, all he had to do is keep the same technique, but to add an ili-hem graft, that strip of cartilage inserted in the ili that keep the ili in the proper position to make up for the verticalization of the lower lateral. You can observe the nose in the profile, three year post-op. And then, we move to a patient that presents some asymmetry. This patient, you need to do one more step to have the symmetry and more aesthetic position. She presents a wide tip and wide nasal base. In this patient, you do a cadaver hinge flap. The cephalic portion, you put on the top of the caudal portion of the ili cartilage. That's enough to make it strength and find some symmetry between the nerves and the tip of the patient. Now, you start the transdermal suture the same way, and you observe the tip in a more aesthetic position for the patient with three year post-op. And the profile also showing a tip-dorsal relationship. That's a, I like the high dorsal that keep more aristocratic profile. That's a very... Now, you have the third patient, three. That's Hispanic. Hispanic patients, as you know, we shall have many Hispanic patients in Brazil. And some characteristics, she presents a thick skin and almost always, how much was it good, weak cartilage support. Because frequently, you'll find in this patient weak cartilage support and under-projected tip. This patient requires a more invasive technique, like open technique, extracted rhinoplasty. And operative planning includes low lateral cartilage grafts and a tip graft. Now, you can see a low lateral cartilage strengthening, just make it more reliable. Of course, I think it's very useful, the strut cartilage graft. And then, the tip again with transdermal suture, trying to highlight as much as possible the dermis. And it should be enough, but it's not. Some defects, of course, and this patient needs a tip graft because the fixed patients, if you don't do that, you don't have a more refined tip. As you can see, this patient with three years post-op. And the profile showing a tip-dorsum relationship. Basal light view. Showing ALA, basal narrowing. The idea in this patient is just to, not to change completely the racial characteristic because it would be bizarre. You just make it less visible, the facial traits, racial traits. Now, secondary rhinoplasty. This is a perfect, perfect example of the importance of using the extracted technique. This patient presents, show a damaged skin tissue element, envelope, skin tissue envelope, deficient structural support. She presents short nose, over-rotated tip, scarred nasal tip, soft triangle retraction, bilateral ALR retraction, and pinched tip. Before anything, you must improve the skin condition, quality. So we're going to perform a fat graft in this patient to allow to do all the extract technique needed. We start with fat harvesting. Harvesting should be abdomen or inner knees. We like to centrifugate it for three or four minutes to refine the grafting. And then with the canola, 3.5 canola, we're going to make the grafts on all the nose. These grafts, it's just to improve the skin quality and create some plane of dissection, undermining, because it's very difficult to do the undermining patient with scarred skin, soft tissue envelope like that. Now you can see the result in operative table. Just the skin look more glow, no glow in the skin. It's nice to see the effect of these grafts just right after the fat grafting. And then after three weeks, you're going to do the operation, the extract operation. All she has left for engineers for the extractor is a rib. And you're going to take the perichondrial first. You're going to to camouflage the grafts. And you can see the rib harvesting. A good piece of excellent source of graft, the rib. You can take as much as you can. And you have a very good, you have three for two and a half. Then I think the difficulty and the secrets of this rib graft is to fashion the grafts properly. When we split it, if you don't do it carefully, you can spoil and damage the whole graft. Just take your time to split it and make the different design of grafts. I'm now designing the cheat grafts. Am I going to wrap it, as you can see, the wrap with wrapping with perichondrial that I harvested before, because I want to make it smooth and start the operation. Now it's open, of course. I like to do an inverted V in the columnella. And then that's, take your time to make the undermining because there is no special plane of the section. You have to be very careful not to buttonhole the skin. I use the sector extension grafts to the space, as you can see in this drawing. Lateral struts, lateral crural strut grafts, that's going to push those forwards. I use the back grafts just after the cheat grafts to avoid the cheat grafts to bend upwards. That's not desirable. I'm fixing it and then finishing the operation. And you can observe the results, two years post-op. It's amazing how the skin has improved just with the fat grafts. And, of course, the structure of the graft, and it has just showed a more aesthetic view. I like the smiling photo because when you smile, the tense nose shows any irregularity that could appear eventually. But you have just a feel, if you compare to the pre-operative. And even the soft triangle, it managed to round it. That's an area, as you know, is very, very tricky, very difficult to symmetrize it. And then you see the profile to the extension graft, septal graft, that works nicely. In summary, structured rhinoplasty should be used whenever there is a lack of structural of structural support, with open technique, of course. On the other hand, closer technique should be the choice whenever structural support is good enough. Thank you very much, you all. And I'd like, now it's a great pleasure to ask Dr. Marcelo Cunha to present facial rejuvenation. I'm going to watch it. Thank you, Rony. Could you please just close your screen, please? Yes, good. So, good afternoon, everybody. So, I'll just start my talk about neck. So, I'm a member of the Brazilian Society of Plastic Surgery, and I work in Sao Paulo in Albert Einstein Hospital. So, I want to talk about how to select the best neck treatment. I know that in the past few years, the neck treatment has evolved a lot in a better way. So, we have a lot in a better way. So, we have a lot of new, probably, tactics that you can use in our surgery. So, I just want to highlight these special points. So, in my personal learning curve, I have almost 20 years now. It's about 2,500 facelifts. It's my workhorse every day in the hospital, and I think we can discuss a lot about it. So, I think the main thing that I want to point out here today is to customize our treatment. So, there's no one technique for everybody. We're going to see that we have very different kind of necks. So, I just select these two patients. They are two real patients from my office that came from a facelift and neck lift. Excuse me, doctor. We can't see your screen. Can you share your screen, please? Oh, sorry. Just one minute. Not yet. Have you shared that with the green button? Yes, there we go. Okay, where did I stop? So, I'll start again. So, can you see now? I'm in the same page, how to select the best neck? Yes, thank you. So, okay. So, how to select the best neck treatment? We have different kinds of patients in our office. So, in my personal learning curve, it's almost 20 years right now, and I have almost 2,500 facelifts. It's really my work host every day in the hospital. And I think the main message that I want to leave here today is to customize our treatment. We have very different patients that come in for facelifts and neck lifts, and we have to be able to do different kinds of techniques to all of these patients. So, this is two real patients that came into my office. One is a 50-year-old patient, a woman with very atrophic skin and very, very thin face. And the other is a man, just a male patient, 65-year-old with a very heavy neck and very poor cervical mental angle. So, I think these two patients make it very obvious that you cannot use the same surgery for both. So, I find it very simplistic when I hear some patients, every kind of a friend or doctor telling that they just use one kind of technique for every nose, or if they don't open 100% of a nose, or if they open the middle neck in 100% of the case. Obviously, they are very different ones, and you have to treat it differently. So, I want to show you some first videos that I want to show schematic steps that I use in my everyday surgery. So, this is the animation that shows step-by-step usually what I do. So, usually I start opening the central neck. I start with a very, very conservative liposuction. We can discuss it about later. It is just to expose and undermine the skin, and then I open the platysma bands. After that, we're going to assess the deep neck structures, and usually I remove submetal, subplatysmal fat. I can open and reposition the hyoid, and I can imbricate or shave the anterior belly of the digastric, like I'm showing here. After treating the deep neck, of course, we have to treat the platysma itself. So, usually it's approximated to the midline, and we do almost a subtotal section to denervate these muscles. I always tell that it's very important to free the muscle in the deep surface from the submandibular gland and from the parotids, so we have appropriate mobilization of this. So, if you go to the next surgery, I want to show in a live surgery how I do these steps. So, usually it's my daily routine. I start treating the skin itself. I do laser resurfacing in 90% of my patients, where I think it can improve the quality of the skin, and I start the surgery harvesting fat. Usually, I use 8 to 20 cc of fat grafted in almost all the patients. So, I start with the central neck, like I showed. The liposuction itself is just to remove my infiltration. I preserve a lot of the subcutaneous fat. I think it's very important to make a very deep, very thick layer of fat underlying the skin, and I remove the excess of the platysma bands. I think it's just imbricating the platysma bands and leaving all this excess tissue there. I think it promotes more recurrence of the bands in the long term. So, I remove the excess of the skin. It exposes the subplatysmal fat, like you're seeing here. In some of these patients, the subplatysmal fat is very big, like I'm showing here. It goes from one submandibular gland to another. So, I remove a lot. I shave the digastric, and sometimes I shave a little bit or I remove the superficial lobe of the submandibular gland as well. I do not touch the submandibular gland in all of the cases. It's a minority of the cases. I think that subplatysmal fat in the digastric, you increase no morbidity to your surgery itself, but I think you have to touch the submandibular gland just when it's extremely necessary. Then I treat the thoracic chin. I like to remove the excess of tissue that's hanging. It's a Joel Feldman's technique that I like, and I like to give his credits because I learned it from him. I like to remove the jaws directly, not by liposuction, but under direct visualization. I remove with my scissor the excess of fat that's in the jaw. I always do a high mass flap combined with the platysma flap. I think it gives a very good mobilization of the middle third. I think it can improve the mandibular border and the contour of the angle of the mandible as well. As you see here, the flap is repositioned in the temporal fascia. I can use or not the excess of the tissue. If I want to increase volume in the middle third or in the bale area, I can just fold this excess of tissue and give more volume. In this specific case, I just judged that she had enough volume, so I removed the excess of tissue. I like to approximate the tissue itself. I don't like long sutures because I think it cannot have a long last result if you rely on the suture itself. I rotate the posterior flap to the mastoid. One of the key points is to fix your mass platysma flap to very stable and fixed structures like the mastoid fascia, the temporal fascia, and the auriculoplatysmal ligament in front of the ear like you're seeing here. In these three important points, I use permanent sutures. I use 3O nylon and the knot is buried under the very thick flap of this mass, so I don't have any probably palpating the knots. If you're just doing placation, you have to be careful with permanent sutures because you don't have the flap to cover the knot itself. You see that everything is in place. I see the contour of the mandible. I remove all of the fat that's below the angle of the mandible, and you see even though I didn't treat the skin or pull the skin yet, you see the result of the cervical mental angle. I do the same in the opposite side. I just like to remember that in most of the case, the two sides are not symmetric, so sometimes you can vary the direction of the pull of this mass in the two sides, or sometimes you can fold this mass in one side and in the other just to remove the excess of tissue. Just be careful when you're fixing this mass just behind the ear to not grab the great auricular nerve or the minor occipital nerve because it gives pain to the patient. You see the cervical mental angle is already defined. There's no thoracic chin anymore, so before I start to remove the excess of skin, I do all the fat grafts. I prefer to just decantation and centrifuge, and you see the immediate result right on the table. You see the result of the neck and the chin itself. It doesn't depend on removing the skin. I just want to show that the angle and the result has not to rely on pulling too much the skin. We're going to see pre and post analysis just to show when to indicate each technique. I like to do the platysma plastic like I showed many years ago, just approximating the midline. I like to combine the central cut of the platysma, this relaxing incision with the lateral one. I just keep one centimeter of the muscle, I think we can denervate a little bit the platysma itself, especially in very active bands. If you see this patient, it's a 55-year-old patient, one year post-op. She has nothing to do with the deep neck surgery, but I see the platysmal band hanging on, so I just superficial the neck. I didn't remove any superficial fat. I just did a high-mass platysma flap and approximating the midline, and she has a very nice contour of the neck. I did the laser resurfacing. I think very fair skin, sun-damaged skin. I think it can improve the quality of your result. I don't have to give any tight appearance to the patient. 77-year-old patient, secondary lift, very heavy platysma bands, with big platysma bands. I think in this case, if you don't remove the excess of the tissue, you're going to have recurrency in the short term. I think, for me, a good result of platysmal band should last at least 10 years. If it comes back after 10 years, I think it's normal. It's due to aging, but I think if it comes back in one or two years, I think it's a technical failure. We have to revise our technique. You see 77-year-old, very atrophic skin. When to remove sub-platysmal fat? Not everyone has sub-platysmal fat. In about 20% to 30% of my patients, I remove sub-platysmal fat. I think, like in this case, you can keep the superficial fat. You can shave the digastric, remove the sub-platysmal flap, and you give a nice cervical-mental angle. Then the patient has a very elegant mandible and neck contour without giving tight appearance to the skin as well. I always like to remember that tightening the skin is not the answer, I think, for the best results. In some patients, we have to reposition the hyoid. I want to show how we can do that. We can remove the superficial lobe of the submandibular gland, or we can just elevate the gland itself by pushing all the flora and the muscles up with our suture. In a patient like this, it's a 65-year-old woman, primary lift. What we're going to see, we improve the cervical mental angle, we shave the anterior belly of the digastric, and we open the hyoid aponeurosis. We want to reposition the hyoid by opening the aponeurosis and approximating the anterior belly of the digastric. It's going to deepen the angle and give a very nice contour. All of the fat graft, laser resurfacing, blepharoplasty, everything is done at the same time. Usually, in the normal surgery, it's very common to do everything together, especially in Brazil. Usually, a surgery takes four, four and a half hours to do a complete treatment like this. This patient is very interested because we improved the angle by repositioning the hyoid. We treated the digastric just by shaving, and we just injected fat in the chin. She's a medical doctor. She didn't want any plant in the chin. I think one of our good alternatives is to improve the chin with fat grafts. Usually, three to five ccs in the chin gives a very nice and predictable result. You see the contour of the mandible as well. When we have to treat the subvandibular gland or reposition the hyoid, you see this. I just finished a 51-year-old woman. She never had the angle, even when she was very young. We can change completely the contour. If you just tighten the skin, it's going to make it more difficult to deepen the angles, the opposite that we think. In this patient, I removed almost nothing of skin, just a few millimeters of skin behind the ear. I treated the chin as well. I put the polyethylene implant, and I treated digastric, hyoid, subplatysmal fat, and she had a very nice contour. I did a direct lipectomy of the jaw as well, and improved the contour of the mandible. In the last case, it's very interesting because the deep neck surgery doesn't depend on the skin itself. You can have a 42-year-old man like this with almost no incision. I just did a submental incision on him, and I did all the deep neck structure. I did a polyethylene, a big implant in the chin. I treated the anterior belly of the digastric. I repositioned the hyoid, removed subplatysmal fat, and just with a small incision under the chin without any skin removal, we have a complete change in the relationship with the chin and the neck. It's a kind of surgery that you can use even in very young patients. I like to do the fat graft to the mandibular border as well. I usually use not only the angle, I use four or five cc's in the angle and the border of the mandible. Thank you very much for Bonet to share with you all these lectures. Hello everybody. It's a pleasure for me to participate in this webinar series. Thanks ASPS. Thanks my great close and brotherly friend, Rony Pitombo, for the invitation. And my presentation is about bird restoration, nowadays my favorite surgery. A normal man has around 25,000 hairs in a full bird, including the moustache, goatee and neck area. To get an acceptable cosmetic result, it's necessary 10,000 hairs, remembering that the neck area is fairly included in our surgical planning. To get this number, it's necessary to place around 35 to 40 follicular units per square centimeter. Like in this patient, for instance, that in my opinion had a good result. It's very important to scan the face with several squares. It facilitates the count of follicular units in each centimeter square. Each one of us has an individual mapping of the direction of the bird growth. But, fortunately, this pattern of growth direction of bird hairs repeats in most men and facilitates enormously the surgical planning, mainly in big or less patients. But when we have a patient that has her bird failed, we have to obey the direction of the remaining hairs. The planning is very important. I trace an inferior line that goes to this sideburn area until the goatee and passes a half centimeter below of the jaw edge. I perform this imaginary line that goes from the angle until the inner corner of the inferior eyelid. And I mark a point six centimeters up and give a weight of this bird. A superior line goes from the same sideburn area, passes through this point until the labial curvature. So, we give the design of the new bird. You can observe in the left side a more orthodox, a more normal design. In the right, the weight increases one and a half centimeters. Here, six centimeters. Here, seven and a half centimeters. The patient goes to the mirror and chooses the drawing he thinks is more beautiful for him. It's very, very important to join the mustache to the goatee. It gives a very good appearance. And this inverted triangle that joins the inferior lip to the goatee is very requested for the patients. This is my arsenal, FUT technique, FUE technique. Long hair sticking place, Leo's scalp implanters and needles. I'm going to talk about each one. It doesn't matter FUT or FUE. Personally, I prefer FUT. It's faster and easier to get long hair. FUE increases enormously the surgical time. And beard restoration is a long, long procedure, around eight, nine hours. I use FUE for scars and small procedures like this. And when I use FUE, I use the neck area for the donor area. Long hair, for me, is a watershed in beard restoration. In hair restoration and beard restoration mainly. It's an invention of a Brazilian surgeon, Dr. Marcelo Piton from Belo Horizonte. And it's very important to give the correct direction and angulation of the hair. Leo's scalp is my favorite instrument. Although I use implanters as well when I'm grafting the mustache region. Ergonomics is very important. I operated all the time seated. Elbows very well supported. You can see the patient's head is literally on my lap. I prefer general anesthesia because it's safer. And becomes the procedure faster than local anesthesia with sedation. Long hair and angulation, I told you about that. I use stick and place technique. For me, it's a very good technique for grafting. And it permits me a correct angulation around 20 degrees to the skin. And a perfect direction of the hair. This is a very, very good technique. And I perform here the stick and place. You can see using the Leo's scalpel. And I stick. And my auxiliary place, the graft. Some results. This patient with a failed beard has a contemporary standard of male beauty. Unshaved look. Four to seven days without shaving. This is the look of the world, of the band of the world. You can see here the same patient. Now with another look, a full beard look. The same patient. In the pre-op and one year after surgery. And here a close-up to show you the direction and correct angulation of hair. The same patient with another look. Another beardless patient with a full beard look. You can see the result. Take a look and pay attention to the direction of the hair. And angulation of the hair. To join the moustache to the goatee is very important and very requested for the patients. Another. Same patient, beardless, completely beardless. And a full beard look. Failed beard. And the patient requested me to join the moustache to the goatee. You can see the difference. One year after surgery. You can see. Failed beard. And this region is completely. Another patient with failed beard. You can see the result. Failed beard. Another patient. Two looks. In this look, unshaven look, four to seven days without shaving the face. Without shaving the beard. You can look at this patient and here another look with a full beard look. Failed beard. Six months after surgery. Six months after surgery. The left side. And one year after surgery the same patient. Front. Right side. Left side. Take a look to this direction and angulation of hair. To join the moustache to the goatee. And the inverted triangle here. And the inferior lip to the goatee. Beardless patient. Unshaved look. The same patient with full beard look. Full beard look. Observe the direction. The joint. The moustache. Right side. Left side. Observing the direction. The same patient. Now. Full beard. And here. Cutlet. Goatee and the moustache. Sideburns. Moustache and cutlet. Two looks. Pre-op. Unshaved look. Full beard look. And goatee and the moustache look. Another patient. Failed beard. You can see we join the moustache to the goatee. This inverted triangle gives a very good appearance to the patient. And these. The joint, the moustache and this triangle are very requested for patients. Left side. Failed beard. In my opinion, a very good result. Thank you very much for your attention. And I'm here awaiting the questions. Thank you very much again. I can't see Marcelo, now we can start the Q&A, yes I have to, now let's see, let's talk with the people. I think Marcelo has to be on the screen to talk with the moderator. She said when she stops sharing the screen, it's time to start the Q&A. No, stop sharing, stop sharing. Now when she stops. I have to be on the screen now, let's see it. I'm seeing you, Rony. Marcelo, if you stop the screen now, Marcelo. Dr. Portombo, you can start the Q&A now. Okay, perfect. Hello, everybody again. It's really, I'd like to welcome again everybody who are the participants of this excellent educational platform that's in Brazilian society. I'm very happy to have the 8,000 participants. Let's talk about, first I'd like to make some comments about the presentation. It's really curious and amazing, this beard restoration. You see something that is very nice and very interesting to see how it works. Very nice presentation. And Dr. Marcelo also, I know him for a long time. Excellent presentation, as always, very didactic. And I have a couple, I must congratulate both for the great presentation. Thank you. I have a couple of questions to both, and I can't see Dr. Carlo, but I can see very clear Dr. Marcelo. Let's start with a couple of questions direct to the rhinoplasty. First one, what the difference between semi-closed and preservation technique? The preservation technique go all the way under the perichondrial. On the other hand, the semi-closed go just on the top of the perichondrial. And the ligaments, of course, you just change in place. In the preservation, you keep the ligaments. And other difference that I think is very important with the infracartilaginal incisions, the preservation techniques go extended all the way until the crura fits. On the other hand, the semi-closed is shorter. The infracartilaginal incision goes until the lobe of the nose. The second question I received here is, in the both technique, preservation or semi-closed, how can you tell where the precise domal location is? You have to find out the precise domal location to perform the transdomal suture. Now, that's very easy. When you pull the cartilage out of the nostril, at the highest point of the pull, highest point is located the domals. Usually, it's the location where the lateral crura is narrow and become medial crura. That is a precise point. Let's move on to some questions about the fish rejuvenation. Dr. Marcelo. Dr. Marcelo, how can you achieve a long-lasting result in platysma band treatments? Rony, I think there's a lot of important tricks, but I'll highlight three of them. I think the first one is very good mobilization of this mass platysma. I always want to point out that it's very important to release the deep surface of the platysma. The platysma is very strong attached to the submandibular gland and to the parotid. I think it's just placation, just imbrication without removing the deep surface. I think it can come back very early. The second one is remove tissue. The first one is mobilization. The second one is to remove the excess of tissue. The third one is denervation. I think especially in active bands, I think relaxing incisions are important. I don't like to do total, I do a subtotal incision. I think even the vertical incision in the lateral part, I think it helps to denervate a little bit the platysma. I hope I have answered that difficult question. It looked very clear. It sounds very clear to me. Dr. Marcelo, another question I'd like to know. I always have this question in my mind. Which is your number one technique to treat which chin? I have tried many. Dr. Pitanghi, when I came from his clinic, he used a different one that he called an inverted T. I used many of these techniques, but I found out a very good one from Joris Feldman's book. I want to give credit to him. It's a very simple one. I remove all of the tissue that's hanging down the inferior border of the chin. I just undermine with a thick flap of skin and fat from the chin. All of the tissue that's hanging below the inferior border, I just remove it completely. There's no chance of recurrence. I think it's simple, objective, and very effective. Good. Very good. One last question for you while we wait for the chat. Which are the effective maneuvers that you think to deepen the cervical mental angle? If I just want to point one, I think it's removing the sub-platysmal fat. I think we have to be careful not to remove it too much below the anterior belly of the digastric, so you won't create any depression there. But I think if you remove just very close to the hyoid, I think this is the most important maneuver. There's other ones, but I think this is the most one. Good. Perfect. Now, I think I have to congratulate all the speakers and also the brilliant organization by Dr. Romina, Dr. Cassandra, and Laura that have done great work organizing this webinar. Thank you very much for all. Thank you.

rhinoplasty

facial rejuvenation

beard restoration

Bonito Tom

structured rhinoplasty

preservation rhinoplasty

customized neck treatments

cosmetic surgery

personalization