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In our facility, consisting of a network of 221 clinics, the top three injectable agents used for rejuvenation purposes are Botulinum toxin, hyaluronic acid, and polynucleotide fillers. While traditional injection therapies aimed to compensate for fat and bone atrophy and alleviate muscle contraction, recent patient demand has shifted towards injectable treatments focused on improving skin texture. Polynucleotide therapy for skin rejuvenation which our group adopted in July 2018 for improving the skin quality has been more popular overtime. We performed 110,973 cases in total from July 2018 to the end of August 2024. <br/>We investigated the number of treatments of polynucleotide alone group and polynucleotide + botulinum toxin group, and number of adverse events and patient’s satisfaction from our database and medical record from 2018 to the end of August 2024. The aim of this study is to analyze the difference of both group and the recent trend of the entire polynucleotide therapy.<br/>Since 2022, when a mixture product of polynucleotide and botulinum toxin, the number of cases of polynucleotide + botulinum toxin combination therapy (n = 71,704; June 2022 to August 2024) has been higher than the number of cases using polynucleotide alone therapy (n = 38,769), which is one of recent new trends on polynucleotide therapy. The entire number of polynucleotide therapy was 110,973, which has been increasing year by year since 2018 (n = 1,975 in 2018, n = 5,078 in 2019, n = 4,536 in 2,020, n = 6,463 in 2021, n = 17,730 in 2022, and n = 39,197 in 2023, 35,994 in August 2024). <br/>We can see from the above history of the number of the entire polynucleotide therapy that the total number of polynucleotide therapy cases increased dramatically in 2022 when polynucleotide + botulinum toxin combination therapy was adopted. Drawing from our facility's case statistics on injectable therapies, we will present the evolving trends, along with protocols for combination injectable treatments that offer improved skin texture in fewer sessions. We will discuss the safety, efficacy, patient satisfaction, and repeat rates associated with these combination treatments, supported by a review of relevant literature.

Abstract –Multilayers injection technique (MIT) for tear trough treatment<br/><br/><br/>The tear trough deformity and periorbital rejuvenation is one of the most challenging areas to treat. There are many modalities to consider, such as fillers, toxins, surgical options or a combination of all of the above. Achieving good results with just fillers alone depends on a good injection technique as well as the choice of filler material. Many cases do not present themselves with just a tear trough deformity but include factors such as poor bone structure, herniated lower lid fat pads, skin laxity and volume loss. Evaluating and choosing the right patient for this treatment is also crucial in setting patient expectations and achieving more than satisfactory results.<br/><br/>As the periorbital area is delicate and difficult to treat, complications occur frequently with filler injections. Common complications include bruising easily, edema, lumpiness and irregularities. In certain cases, satisfactory results would be achieved immediately after injection, but patients will complain of lumpiness or irregularities during the follow-up session one month later. <br/><br/>Traditionally, fillers are placed medially above the orbital rim as well along the area of hollowing. Dr Huang will reveal his unique concept of treating the tear troughs, his choice of filler material, and explain in detail the sequencing of his multi-layer injection technique. His distinctive injection technique has been refined many times and this concept can be used to treat majority of cases with a decreased rate of the common complications associated with tear trough filler injections.

Background:<br/>The periorbital region is one of the earliest areas to show signs of aging, including fine lines, wrinkles, skin laxity, and hyperpigmentation. These changes are driven by intrinsic and extrinsic factors such as collagen degradation, repetitive facial expressions, and environmental damage. Energy-based treatments, including radiofrequency (RF), ultrasound, and laser therapies, have emerged as effective non-invasive solutions for periorbital rejuvenation. These technologies promote collagen remodeling and skin tightening with minimal downtime.<br/>Objective:<br/>This presentation evaluates the efficacy and safety of various energy-based treatment modalities in the rejuvenation of the periorbital area, used alone or combined with surgery.<br/>Conclusion:<br/>Energy-based treatments provide a safe, effective, and non-invasive option for periorbital rejuvenation, delivering notable improvements in skin texture, tightness, and fine lines and brow elevation.

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