JULIA APAC Webinar 2026 Ep 03 Recording 260626

Introduction to the Webinar

Welcome and Overview

• The webinar begins with a welcome message from Teda, the moderator, inviting participants to introduce themselves.

• The topic of discussion is "Confidence Beyond the Face: Look Volume Expanding Applications in Body Enhancement."

• Dr. Matelda Weni is introduced as the speaker, highlighting her qualifications and expertise in aesthetic medicine.

Dr. Weni's Presentation on Volume Use

Focus Areas

• Dr. Weni discusses her approach to using volume beyond facial applications, specifically targeting neck and décolleté areas for skin quality improvement.

• Emphasis is placed on enhancing skin quality rather than dramatic size changes; goals include improving contour confidence and addressing issues like thinning skin.

Mechanisms of Action

• Volume application leads to gradual tissue remodeling and dermal density enhancement, positioning it as a regenerative biostimulator rather than a conventional filler.

• Five interconnected mechanisms are outlined that contribute to rejuvenation: stem cell activation, collagen synthesis, basement membrane regeneration, angiogenesis, and adipogenesis.

Understanding PDLLA Behavior

Unique Properties of PDLLA

• PDLLA (Poly-D-Lactic Acid) acts as a biodegradable scaffold that interacts with tissue environments post-injection.

• It triggers macrophage responses leading to extracellular matrix remodeling and improved collagen production.

Clinical Implications

• The M2 macrophage response supports repair processes which enhance tissue resilience—critical for neck and décolleté treatments.

Basement Membrane Support

Importance of Basement Membrane

• Chronic UV exposure damages the basement membrane; PDLLA helps reduce this damage by decreasing inflammatory signaling.

• Treatment focuses not just on wrinkles but also on improving overall sun-exposed skin quality.

Angiogenesis Induction

Vascular Health Improvement

• PDLLA may induce angiogenesis which enhances vascular signaling crucial for effective tissue repair and collagen synthesis.

Clinical Outcomes Post-PDLLA Injection

Long-term Benefits

• Histological studies show improvements in collagen organization and density after PDLLA treatment compared to untreated skin.

Gradual Tissue Improvement

Regenerative Volumization Concept

• Juvel volume promotes gradual improvement through biostimulation rather than immediate volumizing effects; it supports structural restoration over time.

Adipogenic Signaling

Role in Soft Tissue Density

• Adipogenesis refers to fat cell formation; PDLLA supports signaling pathways that guide stem cells towards mature adipocyte differentiation without guaranteeing large volume increases.

Translating Science into Practice

Treatment Protocol Development

• Specific clinical problems require tailored mechanisms (e.g., treating creepy neck skin needs collagen remodeling).

• A structured protocol includes patient selection based on individual conditions such as thin or crepey skin.

Case Studies Overview

First Case Study: Miss Age (59 years old)

• Concerns: Thin neck skin with early horizontal lines.

• Goal was improving dermal density and softening superficial lines.

• Results showed smoother texture one month post-treatment.

Second Case Study: Mrs. C (47 years old)

• Concerns: Early aging signs including rough texture.

• Focused on early intervention for better outcomes before severe laxity occurs.

Third Case Study: Mrs. (63 years old)

• Concerns: Advanced aging signs including chest wrinkles.

• Results indicated significant surface quality improvement across treated areas after one month.

Fourth Case Study: Another Patient (55 years old)

• Similar concerns regarding moderate aging signs were addressed with positive results noted in smoothness and evenness of texture post-treatment at one month follow-up.

Summary of Key Learnings from Cases

1. Treatments should focus on regenerative enhancements rather than merely filling void spaces or erasing every line.

2. Subtle improvements can significantly boost patient confidence without creating an overfilled appearance.

Transitioning to Body Enhancements

Breast Rejuvenation Cases Overview

1. First Breast Case:

• Patient aimed for natural breast shape restoration without implants; results showed improved upper pole projection while maintaining natural dynamics.

2. Second Breast Case:

• Addressed heavy lower pole tissue concerns; emphasized limitations of non-invasive treatments versus surgical options when significant sagging exists.

3. Final Body Extension Case:

• Focused on gluteal contour refinement without large volume augmentation; demonstrated how juval improves both skin quality and subtle contouring effectively compared to traditional fillers alone.

Conclusion & Final Thoughts

1. Juval volume should be viewed primarily as a regenerative support tool rather than a direct replacement for surgical interventions or large-volume corrections.

2. Successful outcomes depend heavily on proper patient selection, preparation protocols, uniform distribution during treatment sessions, along with realistic expectations set prior to procedures.

Injection Techniques for Neck and Decolletage

Local Anesthesia and Injection Preparation

• The local anesthesia begins to take effect before injecting the product. It's crucial to prime the panel prior to injection.

• For neck treatments, a maximum of two entry points is preferred to minimize visible puncture sites; however, additional entry points may be necessary based on clinical needs.

Marking and Product Distribution

• The treatment area is divided into smaller sections to ensure even product distribution. Approximately one milliliter of product is used per marked area.

• A total of five milliliters is typically used for the neck area, including four small areas and one supra-clavicular point.

Injection Technique

• A superficial fanning technique with slow, even distribution is employed. Mild resistance may be felt during injection but should not lead to forceful maneuvers.

• Consistency in technique across all marked areas is emphasized, with approximately four milliliters used for one side of the neck.

Positioning During Procedure

• The injector's position should prioritize comfort for both the injector and patient. Changing positions during the procedure can help maintain control.

• If maneuverability from a single entry point becomes difficult, creating additional entry points is acceptable as long as it’s communicated clearly to the patient.

Treatment of Decolletage Area

Injection Strategy

• After treating the neck, around one milliliter is injected into the supra-clavicular area using similar techniques aimed at improving skin quality.

• For decolletage treatment, typically one or three entry points are utilized depending on chest width; longer cannulas may facilitate easier product distribution.

Adjusting Product Volume

• Out of 20 milliliters prepared from one file, after using five milliliters for previous areas, remaining volume should be adjusted based on clinical needs rather than always using all available product.

• Focused application in specific areas (e.g., medial vs lateral chest aging signs), allows customization based on individual patient assessments.

Protocol Considerations

Importance of Individual Assessment

• Emphasis on personalized treatment protocols over fixed techniques ensures better outcomes tailored to each patient's anatomy and needs.

Superficial Treatments Post-Injection

• Following deeper injections with Juvederm Volume, a more superficial treatment using skin boosters or Juvederm Soft can enhance results; dilution ratios are specified for consistency in practice.

Managing Patient Comfort

Techniques to Reduce Discomfort

• Preference for device-assisted injections over manual methods aims at reducing discomfort and minimizing bruising risk due to sensitivity in treated areas like the neck.

Immediate Post-Injection Observations

• Observations post-injection show minimal redness or bruising after applying both Juvederm Volume and skin boosters effectively.

Q&A Session Insights

Concerns Regarding Breast Injections

• Current evidence indicates no increased breast cancer risk from collagen-stimulating injectables; however, long-term data remains limited. Patients with suspicious lesions require careful evaluation before procedures.

Massage Recommendations Post-Treatment

• Gentle palpation post-injection is acceptable; however, vigorous massage isn't part of standard protocol following volume injections as it could disrupt results.

Treatment Frequency Recommendations

• One file (20 ml reconstituted volume ) suffices for treating both neck and decolletage areas effectively within a single session while recommending follow-up sessions spaced appropriately based on individual patient conditions.