The difficulty of the surgery of gigantomatic breast is the ability to keep the vascularization of the Pam . the irradiation majors the risks of devascularisation and pam and gland necrosis

The breast reduction by the supero internal pedicle is a worldwide technique khnowen to be easy and simple to do even for gigantomastic breast .

We receive a patient who complains about the big volume of her breast , fleche 27 CM at the left breast and 30 cm on the right one  and which has a previously ( ten years ago ) a tumorectomy and local irradiation on her supero externe quadrant on her left breast

We choose the supero internal pedicle for his security and easy technique and because the irradiation doesn ‘t affect his vascularization

The results was satisfaying without any vascular or necroziting complications

We started our experiment with regenerative medicine in 2001 with PRF technique, which allowed us to obtain fast and good quality healing in the oral cavity, this experience make us spontaneously adhering the use of PRP biological glue as a means of stimulating cellular regeneration in a traditional way with sample blood tubes.

The PRF glue contains key factors involved in tissue repair mechanisms.

We have noticed that the quality of granulation tissue is better with the addition of the APRP which will be much more conducive to receiving a skin graft and allowing its maximum integration.

So we manage some complicated cases using APRP and a simple skin graft while in this kind of situation we used flaps.

Small losses of nose substances secondary to a tumor of the nose at the tip and the nostril are difficult to reconstruct. The bilobed flap of Zitelli is the best indication in these cases.

We will present the case of a 60-year-old man with an infiltrating basal cell carcinoma, poorly limited to 6mm in diameter, straddling the tip of the nose, the right nostril and the right paramedian face.The tumor is removed with 3mm lateral safety margins, the reconstruction of the loss of substance is made with Zitelli's improved bilobed flap allowing coverage of the loss of substance without anatomic and aesthetic modification of the subunits of the nose .

Nasal reconstruction must respect morphological, functional and aesthetic imperatives. Unit repairs offer the advantage of repairing loss of substance with skin of the same quality, matched in texture and color, and they reconstruct aesthetic subunits of the nose while maintaining scars within the unit. . The bilobed flap is a double transposition flap whose overall rotation is 90 °, with a rotation of each lobe of the order of 45 °. It must be dissected sub-muscular to ensure its viability. It is intended for losses of substance less than 20mm in size, paramedianes, low columellar tip or that can border the nostril margin.

Medial thighplasty is a surgical technique that’s reduce excess skin and fat in the medial part of the thighs and improve in the same time the skin quality and tone. Because of the changes which occur with age and weight loss, the skin and subcutaneous tissue of the medial thigh region show relaxation from the loss of tone and elasticity, with inevitable ptosis of the tissues. This surgical procedure can be associated with a significant rate of complications especially postoperative edema and scar migration, improved by performing simultaneous liposuction and anchorage sutures to guard against the effect of heavy skin flaps.

A total of 13 female patients presented during the period from January 2014 to March 2019 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 10 patients medial transverse thigh lift was performed, when the laxity was particularly in the upper half of the tight. Whereas, in the other three patients a vertical thigh lift was chosen considering the location of the laxity that toke the whole tight. In both groups an aggressive liposuction was performed and systematic anchorage suture to the colles fascia. All patients recovered well in 2 weeks and showed improvement of thigh contour. No Scar downward displacement or no skin necrosis or seroma was encountered neither labial distortion.

1)Introductions.

The non surgical Rhinoplasty is one of the most recommended and affective procedures for ingactible aesthethic corrections. Non surgical rhinoplasty reserved correction of the post-surjical impertections such as camouflage after surgical rhinoplasty after trauma or for improving the shape of the nose. With combining some fillers and PDO collagen stimulated threads we are able to do this by placing smooth and barbed threads .

The best benefits of this techniqui are that you can get safe and easy results.

2)Main part.

Of cours the most important thins is knowleges of anatomy of the nose.

We have to remember ,that the dorsal nasal artery runs alon the dorsum of the nose,that is approximately 3 mm away from the midline of the nose .It is a very significant vessel that gives blood suppluy to the surrounding tissue ,the needle can be inserted parallel into that blood vessel.

The dorsal nasal artery anastomoses with the ophthalmic,intratrochlear and agular arteries.The widespread embolism through the connected blood vessels manifists as skin necrosis in geographic pattern. It is also a branch of ophthalmic artery so we should remember that propagation of the fillers embolus may cause eye symptoms. The nasal tip area is supplied primarily by the angular and the superior labial arteries,which are derived from the facial artery.

In general,the angular artery,provides the lateral nasal artery,wich passes medially along the cephalic margin of the Lateral crura and gives off caudal branches toward the nostril rim. The superior labial artery originates from the columella to the region between the domes. The lateral nasal and columellar arteries then meet over the dorsal region,forming an alar arcade that runs along the cephalic margin of the lateral crura.This arcade runs superficial to the SMAS.

Superficial to the alar arcade is the subdermal plexus of the nasaltip skin that is supplied by branches of bouth ophthalmic and facial artery system. Venous system also runs superficial to the SMAS along the lateral wall,dorsum,and supratip regions of the nose. One of the most important viens in the nose is the lateral nasal vein ,which runs over the perichondrium of the middle nasal vault .

Analyzing the Nose:

Nasal fillers and threads indications:

-want to wear thear Rhinoplasty

-bridge to thear secondary or tertiary Rhinoplasty

-can’t afford Rhinoplasty

-don’t desire nasal surgery

-should’t have any more nasal surgery

3)Method of procedures:

With HA fillers we can be able to use for dorsume with a 90-degree inclination to minimize the subdermal course of the needle, thus reducing the risk for vessel incannulation. The beveling of the needle is oriented toward the finger compressing the dorsum. The medial dorsum is slightly overcorrected, whereas injection is more conservative laterally. The injected area is gently massaged to avoid bumps. 

For incriase nasal projection  the needle is inserted with a 45-degree inclination addressing the inferior border of the nasal spine.

Injection should start submuscularly with the needle touching the nasal spine. Besides providing tip support, the submuscular injection also lengthens the depressor septi muscle, thus reducing its retracting effect on the tip.

PDO threads have been used for nasal tip projection, dorsal length elongation, and nostril correction. The results of relative length ratios comparing true lateral photographs showed significant increase in tip projection.

Goal and objectives:

• systematization and classification deformity of the nose
• development and implementation of complex correction algorithms that take into account the prevailing factor in the occurrence of this manifestation;
• the study of the optimal combination of treatments for their synergistic effects;
• injection rhinoplasty  with HA-fillers and PDO threads as part of a comprehensive program of beautification of the middle third;
• concept of remodeling the shape of the nose depending on the degree of trauma or other factors  such as previsoious rhinoplasty ,belonging to a morphotype;
• clinical testing of new techniques to demonstrate well-proven quality and safe  medicine for   injectable correction the shape of the nose
• use combine method   PDO threads  with a ha-fillers

Conclusions :

The nonsurgical rhinoplasty technique with HA-Fillers and PDO threads described here proved to be safe, effective, and reliable with excellent patient-reported outcome. It may allow correction of selected nasal defects with reduced cost and minimal downtime.