Pinokio medical Ltd.

29/06/2025

Dr Asenov Mila from Bulgaria will be invited as international speaker. She is ENT doctor who follows Dr Asen who is his father and very passionate to join all kinds of meetings. . Even she is young as residentship but her knowledge and experience is much more than expected!.
You can see an ENT legacy passed down through generations in Kuala Lumpur!
Please join PINOKIO2025 because only 2 days left till 2nd early bird

[PINOKIO Symposium 2025 Registration Form]

https://forms.gle/QWNbQNCxUBqDesQY7

24/06/2025

Now the number of participants and country markedly increased! 80 participants from 21 countries will join PINOKIO2025.
There are only 4 seats for the Cadaver workshop on 3rd day.
So please hurry up to join PINOKIO2025
We make an unforgettable day for you!

[PINOKIO Symposium 2025 Registration Form]

https://forms.gle/QWNbQNCxUBqDesQY7

21/06/2025

Dr. Leow Aikming is director of Elegant plastic surgery center in Malaysia and best friend of mine in the world. He takes role for local chair and host for PINOKIO2025. And he also moderator for Cadaver workshop as well as cadaver teacher.
He will talk 4 lectures in PINOKIO2025 as distinguished surgeon.
Only 4 seats for cadaver workshop left! And 2nd earlybird terminates till June 30th.
So please hurry up to register and enjoy PINOKIO2025!

[PINOKIO Symposium 2025 Registration Form]

https://www.amsc.com.my/amsc-pinokio/

21/06/2025

21/06/2025

It is my great honor to once again invite Professor David Daehwan Park to PINOKIO2025 in Kuala Lumpur, just as we did in Bali for PINOKIO2023.
He is not only my esteemed mentor but also a respected colleague from Daegu Catholic University, with whom I have shared many years of academic and surgical collaboration.

As one of Korea’s foremost experts in eyelid surgery, Dr. Park will be presenting an advanced lecture on ptosis correction.
If you are interested in upper eyelid aesthetics and function, don’t miss this valuable opportunity to learn from a true master—live in Malaysia.

Originally, the Cadaver Workshop was fully booked, but due to overwhelming demand, we have agreed to open 8 additional seats.
This is a rare chance to join a hands-on, anatomy-based surgical workshop led by world-class faculty.

Please note:
Although the 2nd Early Bird Registration runs until the end of June, cadaver workshop slots may fill up much sooner.
We highly encourage early registration to secure your spot.

[PINOKIO Symposium 2025 Registration Form]

https://www.amsc.com.my/amsc-pinokio/

See you in Kuala Lumpur!

13/05/2025

Dr. Jimmy Yeoh Tze Ming is Malaysian plastic surgeon who is trained in Ireland as well. He will talk about difficult cases about breast like challenging cases. If you want to join PINOKIO2025, click below

[PINOKIO Symposium 2025 Registration Form]
https://forms.gle/QWNbQNCxUBqDesQY7

pinokio2025

09/05/2025

657.
This procedure slims the sides of the head by reducing the size of the temples, creating a narrower and more balanced facial contour. A wide temporal area can be caused by thick temporal muscles, excess temporal fat, or prominent temporal bone. A facial bone CT is often used to assess the cause.

If the temporal muscle is thick, we may partially release it from the bone or perform temporal fasciotomy—loosening the fascia to reduce muscle tension over time. Botox can also be used for a non-surgical reduction.

In cases where the temporal bone itself is thick, part of the bone can be shaved, often combined with muscle reduction, for a more dramatic and visible result.

Why does the temporal region thicken? It's often linked to chronic stress, anxiety, or clenching habits—grinding teeth or chewing hard food as a way of tension release. Over generations, a highly obedient or rigid lifestyle can lead to increased activity in the temporal lobe, possibly influencing skull development. This makes the head wider in shape, especially in cultures with vertical, top-down social structures.

Temporal reduction is not brain surgery—but it does involve the bone that protects your brain, so the decision should be made with care and self-understanding.

[Temporal reduction reshapes the bone and muscle surrounding your temporal lobe.]
—657mm Growing Pine—

09/05/2025

656.
Forehead lift surgery is designed to improve drooping eyebrows and upper eyelid heaviness by lifting the forehead skin and underlying tissues. Over time, repeated facial muscle contractions (frontalis, corrugator, procerus, orbicularis oculi) and skin laxity cause forehead wrinkles and sagging.

As we age, facial bones—including the frontal bone—gradually shrink due to mineral loss. However, the overlying soft tissue doesn’t shrink, so the skin begins to droop with gravity, leading to lowered brows and a tired eye appearance.

For those wanting to lift the brows without visible facial scars, endoscopic forehead lift is an option. Small incisions are made behind the hairline, and using a camera, muscles like the corrugator may be partially removed to soften frown lines. The forehead tissue is lifted and fixed to the bone, sometimes with dissolvable implants. However, certain implants may cause tingling or discomfort when touched later, so material choice matters.

Unlike open lifts, the endoscopic method doesn’t remove excess skin—it repositions and anchors the tissues, so its longevity may be shorter.

In open forehead lift, the incision placement depends on forehead size:

Wide forehead: incision along the hairline; lifts brows and shortens the forehead.

Narrow forehead: incision 2 cm behind the hairline; lifts brows while increasing forehead height slightly.

In both methods, the frown muscles can be trimmed and the periosteum modified to reduce lines and secure the lift.

Ultimately, this surgery improves upper-face balance and aging signs. Knowing your facial bone structure is key, and keeping up circulation through aerobic activity may help preserve a youthful look longer.

[Forehead lift enhances facial proportion and counters upper-face aging.]
—656mm Growing Pine Tree—

09/05/2025

655.
This procedure reduces the vertical height of the forehead, but the actual surgical dissection happens at the scalp, not the forehead itself. The scalp is lifted from the crown toward the back of the head and then advanced forward, allowing the forehead skin to be removed without undermining the forehead itself.

Depending on scalp elasticity and thickness, around 1–2 cm of reduction is possible, with an average of 1.5 cm. However, this is not recommended for patients with crown hair loss, as it may worsen thinning due to reduced blood supply.

To keep the hairline natural, the incision is made in a zigzag pattern, angling backward to preserve more hair follicles. During the process, some nerves like the supratrochlear and supraorbital nerves may be cut or stretched, causing temporary or permanent numbness on the scalp—which is a common side effect.

If you can’t accept numbness, hair transplantation may be a better option—but this comes with its own tradeoffs, like lower density. There’s no zero-risk procedure. A good surgery begins with a full understanding and acceptance of its pros and cons.

The surgery takes about 1 hour under sedation. Sometimes, you may notice a subtle brow lift effect afterward, and it can also be combined with forehead fat grafting. This surgery is ideal for people with a long or wide forehead, helping create a better facial balance by adjusting the upper third of the face.

[Forehead reduction is a surgery that reshapes the upper face.]
—655mm Growing Pine Tree—

09/05/2025

652.

Filler treatment for forehead wrinkles involves injecting filler beneath the wrinkle groove to lift and smooth the area with volume and pressure. Unlike Botox, which prevents wrinkle formation, filler corrects existing static wrinkles.

Shallow lines require a delicate technique. If the wrinkle only appears with facial movement, Botox may suffice. But if it’s visible at rest, even if shallow, low-viscosity filler is injected superficially to avoid uneven texture.

For slightly deeper lines, low-viscosity filler can be placed in the lower dermis.
Medium to high-viscosity fillers are used for deep wrinkles, injected in deeper planes such as above the muscle or periosteum.

If a sunken scar is causing the depression, it may be necessary to release fibrotic bands underneath using a V-shaped cannula before filling.

Hyaluronic acid fillers are preferred as they are reversible if complications occur. Other types like calcium, PCL, or PLA fillers may be too rigid and are less ideal for fine wrinkles. (See 604mm)

Vascular complications are a serious risk. If filler enters a vessel, it can block blood flow—leading to pain, pale skin, and even necrosis. In severe cases, high-pressure injections into glabellar arteries can backflow into the ophthalmic artery and cause blindness by blocking the retinal or posterior ciliary arteries.

To minimize these risks, fillers should focus on shallow lines, not general forehead volume. If visual symptoms occur, immediate injection of 150–300U hyaluronidase, warm compresses, massage, and anticoagulants are critical.

Though rare, delayed allergic or immune reactions can cause nodules or inflammation. These too can be reversed with enzyme injection.

Ultimately, while filler can conceal wrinkles externally, it's vital to understand the risks. Reducing overuse of the frontalis muscle, which is activated by fear or surprise, is a proactive way to prevent wrinkles. Inner calm can help protect your face. (See 552mm)

[Filler for forehead wrinkles is a treatment that corrects current wrinkles by filling the base of the crease.]

– 652mm Growth Pine Tree–

05/05/2025

651.

Botox injections for forehead wrinkle correction work by temporarily paralyzing the frontalis muscle, preventing it from contracting and thus stopping dynamic wrinkles from forming on the forehead. When botulinum toxin is injected into the frontalis, it blocks the release of acetylcholine at the neuromuscular junctions of the frontal branch of the facial nerve, preventing signal transmission to the muscle—resulting in muscle relaxation and wrinkle reduction. (See 605mm for reference.)

Once Botox blocks the acetylcholine, the effect typically lasts 3 to 4 months. This means the wrinkle-smoothing results can be maintained for 3 to 6 months. However, repeated and frequent Botox injections—more than 2–3 times per year—can lead to the development of neutralizing antibodies. These antibodies, produced by B-cells in the lymphatic system, may eventually recognize botulinum toxin as a threat and neutralize it before it can work. This immune response is primarily triggered by complex proteins that come packaged with the toxin. To reduce the risk of developing resistance, some newer formulations use purified botulinum toxin that excludes these complexing proteins.

Proper injection technique is also critical. If Botox is injected too low on the forehead, it can overly relax the frontalis muscle that helps lift the eyebrows, causing heaviness, drooping eyebrows, or even eyelid ptosis. This is especially problematic in patients who already rely on their forehead to lift their eyelids due to preexisting eyelid drooping. In such cases, Botox may worsen ptosis and should be administered with extra care.

Another common issue is the “samurai eyebrow” effect—where only the central forehead is treated, and the outer edges remain active. This creates an unbalanced lift of the outer brows. To avoid this, Botox should be evenly distributed, including the lateral frontalis. If the effect has already occurred, small additional injections to the outer frontalis can help restore symmetry.

Because the frontalis muscle lifts the eyebrows and the glabellar complex pulls them downward, it is often more aesthetically effective to treat both areas t