Abstract:   Bingo Wings Treatment by chemical myoplasty and myopexy

Authors: 

1. Alain TENENBAUM, M.D; Ph.D; D.Sc-Facial Plastic Surgeon   

2. Mauro TIZIANI,Molecular Biologist.

What delegates will learn/take away from this presentation:

Delegates will learn (with minimum material, low investment,with some techniques better than threads and/or apparatology) an alternative to surgery to reshape and lift female bingo wings .

 Introduction

Until nowadays the treatment of bingo wings essentially surgical doesnt give entire satisfaction to plastic surgeons as patients because of visible and painful scars .

Also threads arent so much used as the patients expectations are higher than the objective results.

Finally the immediate chemical and medical armlift  is a new weapon for dermatologists and plastic surgeons by using the techniques called Endopeel, which have like mechanism of  action a myotension, a myoplasty and a myopexy which  duration does not exceed 6 months.

Objectives

These techniques can be proposed to patients who wish to get an arm lift , to patients who are not candidates for a surgical brachioplasty, to patients which refuse threads, to patients who want to avoid a painful scar .Most patients are female.

The advantages of these techniques are important for the patients,because of

• the immediate effect with maximal effect after 72 hours with a contention

• the absence of scar,

• the absence of down time,

• the absence of social eviction,

• as the transitory complications which are limited  to short duration ecchymosis.

Patients’ selection

• All patients who desire a surgical or non-surgical Arm lift can be candidates, Best indication is not fatty bingo wings, sagging down .
• Our criters of exclusion :pregnant women, subjects under 18 years, fatty arms.

Benefits and Advantages-Results

• The medical arm lift effect is immediate and is perfectly visible 30 minutes after the end of the treatment with a maximum result 3 days after the procedure ( a contention is necessary 3 consecutive days)
• The treatment can be ineffective in cases of bad techniques ( untrained physicians) and bad indications.
• The treatment can lead to amputation of the arms in case of dangerous copies of the original products ( Argentina,Korea,Spain).
• The effectiveness of this treatment increases with the number or the repetition of the procedures because the basic muscular tone will be thus increasingly high on the scale of the tension of this last 
• It is easy to prove objectively the effectiveness of this treatment by treating for example only one side only on the same patient and by making a comparison between the treated side and the controlateral untreated one by pure visual inspection, or by photographic images, or by using points of reference. Results can be not only appreciated by inspection but also by objective measurements.
• These same parameters are taken again to evaluate the duration of the results objectively.
• The procedure is made comfortable for the pusillanimous patients thanks to the special anesthetic gel applied before the Endopeel procedure and giving satisfaction of painless technique to each patient, because the protocol can be adapted perfectly according to the timetable of the patient and also according to his/her social requirements 
• In the field of safety, so far and since 18 years these techniques started to be used, no legal procedure against a physician using the techniques Endopeel ( with original products) was announced and/or indexed to our knowledge. The only complications met are only transitory, like ecchymosis. 
• The report/ratio benefit cost of the treatment is accepted in the large majority of the cases.

  Techniques -Procedures

• The selection of the patients has been described above. 
• The material to be used is the following:

-                The medical device like oily acid carbolic (original product CE approved DocTNB)

-                Syringes 1 ml luer lock

-                Flexible needles for the body25 or 27g

-                1 needle 18g to aspire the solution of oily carbolic acid

-                An anesthetic specific gel   containing lidocaine 23%, tetracaine 7%, using an emollient lipophilic lubricating gel like vector

-               A post, Endopeel, cold cream cold 

-                Finally one not alcoholic disinfecting product, gloves and gauzes.

• The technique known as standard treats: the sagging brachial area on anterior and posterior as inferior sides. Of course the axillary area is a forbidden area.
• Such areas can be treated if there is no fat excess. In case of fat excess a prior lipoplasty should be done and Endopeel technique can follow generally 1 month after the lipoplasty procedure when the inflammation disappears totally.
• The basic technique consists in injecting in subcutaneous perpendicular to the plan of the muscles 0.10 ml of oily acid carbolic each 1cm and same in the perpendicular plan to the precedent following the direction and the sense to obtain the wished lifting effect using crisscross-technique.
• Errors: The intra vascular injection of carbolic acid cannot be regarded as an error, considering the sclerosing effect of this substance. The injection into the motor plate or any nerve of carbolic acid may slow down the speed of nervous conduction for short duration.Touching the median, cubital or radial nerve could lead to a hypoesthesy of the corresponding fingers during max 90 minutes with complete restitutio ad integrum without any medicines or treatment.
• Safety: It is recommended for toxicity reasons not to inject more than 25 ml/ day/ patient . In case a patient needs more than 25 ml, this technique can be divided in consecutive days, respecting the maximal dose per day per patient.Usual quantities needed  are 7 to 8 ml/ arm.

Conclusions

Until now, the concept of Arm Lift was based only on surgery . With  Endopeel techniques one acts not only on the myotension by preserving the muscular mass and without affecting the muscular contraction but also on the myoplasty and the myopexy .With this fact the indications of surgery become more restricted and will apply only to the extremme sagging bingo wings.

Finally chemical medical arm lift with a handing-over in tension of tissues with tightening effect like the Endopeel techniques give a better shape of the arms. 

The technique Endopeel is a new strategic weapon for the Dermatologists and Plastic Surgeons enabling them to complete and/or maintain an Arm Lift which is an alternative to the surgery.