Shadowing Practice: How to inject the nasolabial fold and avoid complications - Learn English Speaking with Video
Bir pratik modu seçin
Her mod tam ekran bir pratik odası açar.
150 cümleler
Cümleler çok kısa veya çok uzun ise, ayarlamak için Düzenle'ye tıklayın.
1
So it's important to fill the piriform fossa when aging has started to show in that way.
2
So you can sometimes give a little bit of elevation to the to the top lip in certain cases.
3
The way that I was taught many years ago was the one
4
that I think is worth knowing about that I think is most at risk
5
if you do the deep bolus on the periosteum is actually blocking the
6
Today we're talking about injecting the nasolabial fold or the piriform fossa.
7
So why is this area important?
8
So super important part of aesthetics because it's one of the key parts of the face that shows aging quite early on.
9
So I think you can often see this on a 38 year old,
10
you can see the process happening.
11
So nasolabial fold is almost a hinge point on the face.
12
So it's relatively mobile with a couple of ligaments,
13
but it becomes as the cheek descends as you get older and as it loses volume,
14
it starts to become a point where the skin flexes
15
and also where even the three-dimensional shape of the cheek and the midface can change.
16
So it's a place many injectors will look at treating relatively early on.
17
People are way better these days at treating the cheek as well at the same time.
18
But it's that important aspect that it's early and significant in terms of ageing of the midface.
19
Tell me more about the anatomy.
20
So the pre-orbicularis oculi fat pad is the inferior border.
21
You have obviously the muscle just above, just medial to that.
22
The most medial part of the space is the depressor nasi muscle.
23
So this muscle is just the one that pulls your nose down.
24
Laterally you have the deep medial fat pad and then the muscles that pass over it.
25
These are important because just above the muscles is also the fat pad
26
and this is where the artery runs just over the surf,
27
over the roof of the space.
28
So the depths are really important,
29
the three-dimensional anatomy is really important and I was going to show that to you on this little model here today.
30
Okay so this the piriform fossa which lies next to the piriform aperture gets its name from this aperture.
31
So right next to the aperture,
32
and by the way, piriform means pear-shaped.
33
So all it means is it's the shape of the pear.
34
And of course, we like to think of fancy names.
35
Whoops, I've knocked off the depressors, septi.
36
And the little fossa, the little indentation next to the piriform aperture is the area that has a potential space.
37
This means you can inflate it.
38
Some experiments have been done where they put air and also filler into it,
39
and it tends to fill this space.
40
It's a discrete space with several different boundaries that hold it.
41
So importantly, inferiorly, you've got the orbicularis oculi fat pad underneath it,
42
the poof, as we talked about.
43
Then medially, you've got the depressor septi as one of the boundaries.
44
So that's fallen off this model.
45
I'm going to stick it back on.
46
It's the medial boundary.
47
And then over the roof of this potential space is where the fat pad is and the artery.
48
So it's very important.
49
You can see by this structure here,
50
the facial artery and it becomes the angular artery runs over the space.
51
As we roll back the fat pad you can see where the space is
52
and this is really where we should be injecting.
53
The point that's also really worth understanding is if I remove this structure
54
which represents the piriform fossa you can see in the superior
55
lateral aspect of it there are probably a few strands near the bone of the infraorbital artery.
56
So these are the two arteries that can be injured when you're injecting here.
57
You have with this laid on top you have the facial artery where it becomes the angular artery
58
and then underneath it more superiorly and laterally you are very close to the infraorbital artery.
59
You also have the nerves that supply the top of the lip
60
so you will often find patients find this a little bit uncomfortable
61
if you just touch the nerve here but
62
that is a safer way of injecting in many ways than injecting more superficially which we're going to discuss in some detail.
63
So it's important to fill the piriform fossa
64
when aging has started to show in that way
65
And the reason aging demonstrates itself in the Perseform Fosso is because of bone loss,
66
number one, and fat loss, number two.
67
And then thirdly, when you've lost a little bit of bone and fat,
68
the muscles tend to become hypodynamic.
69
So that means they move more as you get older,
70
you get almost caricaturish.
71
So by stabilizing that area,
72
by re-volumizing it, you're going to also provide some support for the muscles
73
that support the lip
74
so you can sometimes give a little bit of an elevation to the to the top lip in certain cases
75
and this also will create a more natural movement
76
or a more harmonious movement when the patient smiles
77
so it's also a way that you can treat the gummy smile
78
and it will also partly support the cheek now i don't
79
most people wouldn't recommend using this injection to support the cheek
80
but it's one of the like I always say a push
81
and a pull go really well together
82
so we need a little bit of push a little bit of pull
83
and this is the support underneath so you can elevate the midface by using that area so there's several reasons to treat.
84
So how do you decide on the best technique to use?
85
It feels more stable to me I think it lasts a bit longer using a deep injection onto the periosteum.
86
The other approach that I might use might be with a cannula
87
but my experience is it seems to be less effective
88
and it is lying usually a little bit more superficial in the fat rather than on the periosteum
89
when you use a cannula
90
and that just has a couple of downsides to it in terms of tissue integration and stability in my experience.
91
So for those reasons I probably use the needle on the bone technique a little bit more than cannula.
92
Depends what else I'm doing on the face.
93
It's often appropriate in different people and more holistic treatments to use the cannula as well.
94
But that's the one I currently use the most.
95
The way that I was taught many years ago was basically to inject just underneath the dermis.
96
And this has definitely gone out of fashion.
97
And it's basically because you have the infralar artery,
98
a branch of the facial artery that comes off just under the nose.
99
It's pretty vulnerable if you're at the wrong level here.
100
And similarly, the facial artery itself is a bit more vulnerable when you're at intermediate depths.
101
For most injectors, there's one thing you do get by going deep is when you touch the bone,
102
you know exactly what level you're at.
103
There's no doubt.
104
So what are the complications in this area?
105
Obviously blocking the facial artery and blocking the infraorbital artery are the most common complications from treating the nasolabial fold.
106
The one that I think is worth knowing about
107
that I think is most at risk if you do the deep bolus on the periosteum is actually blocking the infraorbital artery.
108
So I'm aware of a case where this happened.
109
It's an area where the amount that you use in one spot is quite high and this automatically makes it more dangerous.
110
Anywhere where you're injecting a bolus in one spot,
111
it's safe if you're not in something but
112
if you are in something the scale of the injury is much bigger
113
and this is what I think happened in this particular case
114
which is a blockage of the infraorbital artery and then flowing back
115
and blocking the last part of the maxillary artery because that's where the infraorbital artery comes from.
116
And this means damage to the blood splice in the midface and the nasopharynx and the palate.
117
So really internal type injuries,
118
very awful experience and we would hate that to happen to anyone.
119
And hopefully by watching this it'll make you a little bit safer.
120
I believe what happens in those cases is all to do with angle
121
and I have talked about this before but I'll demonstrate it again on this if we...
122
The facial artery is normally in the fat so if you're putting the needle in like this,
123
you should, even if you go through the artery,
124
you should be touching the bone.
125
So you're going to be safer automatically as far as the facial artery is concerned.
126
The problem with the bony injection comes when you're angled slightly up.
127
So a good place to enter would be about here and you'd be underneath the artery.
128
But if you're a novice injector and you angle up slightly,
129
as you go deeper and deeper,
130
you get more and more superior.
131
You get closer and closer to these little vessels where the infralortal artery enters.
132
And if you happen to land on one of them
133
and they are deeper I've seen this on cadavers you'll find them deeper than the other vessels
134
because they do emerge from the periosteum and then you might block
135
that maxillary artery so it's very important that your angle is correct
136
so it's this sort of angle I mean that changes everything
137
if you're angled up slightly and this can just be
138
that you're standing in a different position on the bed
139
and it doesn't take much much to it
140
but you really want to make sure that you're angled in such a way
141
that as you get deeper you get further away from the infrarbital artery rather than closer to it.
142
So that's a good way of thinking about it.
143
If I go in at this angle,
144
I'm getting closer the deeper I get.
145
If I go in at this angle,
146
I'm getting further the deeper I get.
147
And that should help you stay safer and avoid blocking that blood vessel.
148
Thank you very much for watching.
149
I hope you learned a thing or two about the piriform fossa.
150
Let me know what you think in the comments and we will see you next week.
Uygulamayı İndir
Akıcı konuşmak için ihtiyacınız olan her şey
AI TelaffuzHer cümleyi puanla
IPA AlıştırmasıHer sesi ustalaştır
Kelime BilgisiKelime bankanızı oluşturun
Kelime OyunuOynarken öğrenin
FOR YOU
Video Öner
C14
81 cümleler
Sculptra: Combination Technique
Business EnglishUniversity StudentsWorking Adults
C11
260 cümleler
Quick Thinks: Network Smarter and Make Better Connections
Business EnglishUniversity StudentsWorking Adults
C11
16 cümleler
Cleft Lip & Cleft Palate: Pediatrics - Alterations in Health | @LevelUpRN
Business EnglishUniversity StudentsWorking Adults
C24
186 cümleler
Embolization of AV Malformations: Tips and Tricks
Business EnglishUniversity StudentsWorking Adults
C13
273 cümleler
12 Habits That Are Slowly Making You UGLY (Without you realizing)
Business EnglishUniversity StudentsWorking Adults
C13
106 cümleler
Why the CPC Method Changes How You Learn Medicine (And Why Memorization Fails)
Business EnglishUniversity StudentsWorking Adults
C13
38 cümleler
How to Pronounce: /m/ and /n/ in Final Position
British AccentBusiness EnglishUniversity StudentsWorking Adults
C11
153 cümleler
In 9 minutes, you’ll understand breathwork better than 99% of the planet
Business EnglishUniversity StudentsWorking Adults
B2202 cümleler
Does my tooth really need a filling? By Atlanta's minimally invasive dentist Dr. Andrew Kokabi
Business EnglishUniversity StudentsWorking Adults
C12
134 cümleler
Component Focus #4 - “How Do I Control My Soft Palate?” - Voice Breakdown
Business EnglishUniversity StudentsWorking Adults
B23
388 cümleler
Targeting Belly Fat Is... Possible?! (NEW Study)
Business EnglishDaily ConversationUniversity Students
C19
38 cümleler
The Neuroscience of Learning
Business EnglishUniversity StudentsWorking Adults
Bu dersin kelimeleri ve konuşma notları
Bu C2 seviyesindeki konuşma dersi “How to inject the nasolabial fold and avoid complications” videosuna dayanıyor. En çok tekrarlanan kelimeler: artery, fat, piriform, space, fossa. Bu videoda gölgeleme çalışması için 150 cümle ve 1763 kelime var. Konuşma bölümü 8:05 sürüyor. Konuşmacı hızlı konuşuyor, dakikada yaklaşık 218 kelime; bu yüzden birbirine bağlanan ve zayıflayan sesler duyacaksınız. Kelimelerin yalnızca %80’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodaki en ileri düzey 15 kelime, telaffuzu ve anlamıyla:
| Kelime | Telaffuz | Anlam |
|---|---|---|
| artery isim | /ˈɑɹ.təɹ.i/ | arter, atardamar |
| fossa isim | /ˈfɑ.sə/ | fossa |
| cheek isim | /t͡ʃiːk/ | yanak |
| underneath zarf | /ˌʌndɚˈniθ/ | altında, altı |
| injection isim | /ɪnˈd͡ʒɛk.ʃən/ | enjeksiyon |
| fold fiil | /ˈfəʊld/ | katlamak |
| maxillary sıfat | /ˈmæk.səˌlɛɹ.i/ | çenesel, maksiller |
| pear isim | /pɛɹ/ | armut, kertme |
| angular sıfat | /ˈæŋ.ɡjə.lɚ/ | açısal |
| elevation isim | /ˌɛlɪˈveɪʃn̩/ | rakım |
| anatomy isim | /əˈnætəmi/ | anatomi, yapıbilim |
| needle isim | /ˈniː.dəl/ | iğne |
| cadaver isim | /kəˈdævɚ/ | kadavra |
| discreet sıfat | /dɪˈskɹiːt/ | ölçülü |
| harmonious sıfat | /hɑɹˈmoʊni.əs/ | uyumlu |
Duyacağınız deyimsel fiiller
| Kelime | Anlam |
|---|---|
| run over fiil | çiğnemek |
Tekrar etmeye değer cümleler
Videodan, günlük konuşmada yeniden kullanabileceğiniz kısa ve tam cümleler:
- Whoops, I've knocked off the depressors, septi.
- I'm going to stick it back on.
- Depends what else I'm doing on the face.
- I'm getting closer the deeper I get.
- I'm getting further the deeper I get.
Bu videodaki dil bilgisi
Konuşmacının en çok kullandığı yapılar, videodaki sözcüklerin aynısıyla:
| Yapı | Videoda |
|---|---|
| Present perfect have/has + fiilin üçüncü hâli — geçmişte olan ama şimdi de önemli olan bir eylem | has started · I've knocked · have been done |
| Edilgen yapı be + fiilin üçüncü hâli — kimin yaptığı değil, ne olduğu önemli | was taught · have been done · can be injured |
Dikkat edilecek telaffuzlar
Konuşmacı you're, I'm, you've gibi kısaltılmış biçimleri 33 kez kullanıyor. Bunları duyduğunuz gibi kısa söyleyin.
- “th” sesleri: underneath /ˌʌndɚˈniθ/, thirdly /ˈθɚdli/, aesthetics /ɛsˈθɛt.ɪks/
- “sh” ve “zh” sesleri: injection /ɪnˈd͡ʒɛk.ʃən/, complication /ˌkɑm.pləˈkeɪ.ʃən/, elevation /ˌɛlɪˈveɪʃn̩/, dimensional /daɪˈmɛn.ʃə.nəl/, indentation /ˌɪndɛnˈteɪʃən/
- Uzun kelimeler — vurguyu doğru yere koyun: infraorbital /ˌɪn.fɹəˈɔɹ.bət.l̩/, complication /ˌkɑm.pləˈkeɪ.ʃən/, laterally /ˈlæ.tə.ɹə.li/, maxillary /ˈmæk.səˌlɛɹ.i/, orbicularis /ɔɹˌbɪk.jəˈlɛɹ.ɪs/
Türkçe konuşanların zorlandığı sesler:
- Kelime başındaki ünsüz kümesi — araya ünlü eklemeyin: blockage /ˈblɑkɪd͡ʒ/, splice /ˈsplaɪ̯s/, stabilize /ˈsteɪ.bəˌlaɪz/, strand /ˈstɹænd/, flex /flɛks/
- /æ/ — “e”den daha açık: aperture /ˈæp.ɚˌt͡ʃʊɹ/, cannula /ˈkænjələ/, laterally /ˈlæ.tə.ɹə.li/, maxillary /ˈmæk.səˌlɛɹ.i/, angular /ˈæŋ.ɡjə.lɚ/
Bu videoyla nasıl çalışılır
- Videonun tamamını konuşmadan bir kez dinleyin ve bilmediğiniz kelimeleri not edin.
- 0,75× hızla başlayın, cümle cümle tekrar edin ve kolaylaşınca normal hıza dönün.
- Kendinizi kaydedin ve orijinaliyle karşılaştırın; artery, fossa, cheek gibi kelimelere özellikle dikkat edin.
Gölgeleme Tekniği Nedir?
Gölgeleme, başlangıçta profesyonel tercüman eğitimi için geliştirilen ve çok dilli Dr. Alexander Arguelles tarafından popüler hale getirilen, bilim destekli bir dil öğrenme tekniğidir. Yöntem basit ama güçlüdür: ana dili İngilizce olan bir sesi dinler ve hemen yüksek sesle tekrar edersiniz — konuşmacıyı 1-2 saniye gecikmeyle takip eden bir gölge gibi. Pasif dinleme veya dilbilgisi alıştırmalarının aksine, gölgeleme beyninizi ve ağız kaslarınızı gerçek konuşma kalıplarını eşzamanlı olarak işlemeye ve yeniden üretmeye zorlar. Araştırmalar, telaffuz doğruluğu, tonlama, ritim, bağlı konuşma, dinleme anlama ve konuşma akıcılığını önemli ölçüde geliştirdiğini göstermektedir — bu da onu IELTS Konuşma hazırlığı ve gerçek dünya İngilizce iletişimi için en etkili yöntemlerden biri yapar.