31 - 215 - SOFT TISSUE AUGMENTATION Flashcards
technique in which the needle is inserted into the skin and the filler is deposited in a linear fashion along the track of the needle as it is being withdrawn
Threading
type of threading in which, instead of inserting the needle into a new area each time, the needle is just withdrawn so that a new track can be made radially adjacent to the last
Fanning
an injection is made in an anterograde direction, so that the injectable material flows from the tip of the needle and hydrodissects the tissues as it flows
“push-ahead” technique
This technique is often used in areas where bruising is more likely to occur along the needle track, such as the upper lid and brow
“push-ahead” technique
small “pearls” of material are deposited serially, usually along a fold or deep by bone
depot method of injection
- approach used to diffusely cover an area with the injected material.
- In this method, linear threads are lined up in succession and a second series of rows is then layered at right angles to the first
Crosshatching
- nonbiodegradable, biocompatible, synthetic polymer that is often used in other medical devices, such as bone cement and intraocular lenses
- minuscule, round, smooth particles that are not absorbed by the body.
- When used as a softtissue filler, these beads are **suspended in a gel-like solution that contains cow (bovine) collagen **and are injected into the face.
- A few months after it is injected, the collagen gel breaks down and natural collagen fills out the residual space
- This dermal filler is considered semipermanent, and is most often used to treat medium-to-deep rhytides and folds, particularly the nasolabial creases.
- It is also used by some to fill pitted scars and to augment the lips
polymethylmethacrylate (PMMA microspheres)
- good choice for patients who desire a long period of correction or more volume enhancement
- They are currently approved for augmentation of the nasolabial folds, mid cheeks, and lips, but other common areas of treatment include the labiomental crease and periorbital areas
Hyaluronic acid–derived fillers
crosslinking agent used in both the monophasic and biphasic products of hyaluronic acid
BDDE (1,4-butanediol diglycidyl ether)
- Some hyaluronic acid products exist as biphasic gels containing both crosslinked and uncrosslinked particles, and some as monophasic gels containing only crosslinked particles
- The biphasic non–animal-derived stabilized hyaluronic acid products are made en bloc initially and then passed through a sieve to create particles ranging in size from 10,000 per mL to 100,000 per mL with a hyaluronic acid concentration of 20 mg/mL.
- The smaller particle size permits injection through smaller-gauge needles into finer wrinkles and the larger particle size is best for volumetric filling.
- The small amount of non-crosslinked hyaluronic acid allows for smooth flow with low injection pressures.
- Monophasic hyaluronic acid gels are produced by varying the amount of high- and low-molecular weight hyaluronic acid, producing a hydrogenous gel.
- The monophasic product is available in 2 formulations, one containing 24 mg/mL of hyaluronic acid and one containing 30 mg/mL of hyaluronic acid
Identify the soft-tissue filler described
Treatment of medium-to-deep folds, lips, acne scars, periorbital hollows, facial contouring
Hyaluronic acid
longevity of Hyaluronic acid
6 to 12 months
Identify the soft-tissue filler described
Treatment of deep folds, nipple reconstruction, nasal reconstruction, jawline, malar augmentation
Calcium hydroxylapatite
Identify the soft-tissue filler described
Treatment of HIV lipoatrophy, nasolabial fold, cheek, and temple hollows
Poly- -lactic acid
Identify the soft-tissue filler described
Pan-facial filling, especially periorbital area
Autologous fat
Identify the soft-tissue filler described
Treatment of scars, HIV lipoatrophy, lips, deep folds
Silicone
possible complication: Delayed granuloma formation, migration
Silicone
longevity of autologous fat
5 years or longer
longevity of Poly-L-lactic acid
2 years or longer
longevity of calcium hydroxylapatite
6 to 18 months
approved by the FDA in 2004 for correction of HIV-related facial atrophy and is also approved for the cosmetic correction of shallow-todeep contour deficiencies
Poly-L-lactic acid (PLLA)
- well known as a no-downtime, long-lasting filler with a wide range of applications. PLLA’s uniqueness lies in the fact that it is not a direct filling agent but rather a biostimulatory agent, eliciting tissue thickening over the course of many months and many treatment sessions
- ideal filler for someone desiring a gradual, subtle change
- works by initiating a foreign-body tissue response, it is not suited for patients taking immunosuppressive or antiinflammatory drugs, and it appears to work most efficiently in younger patients with robust immune responses
njection technique used when infiltrating PLLA
diffuse crosshatching and threading
Patients requiring augmentation of the nasolabial folds, labiomental crease, mandibular ramus, cheeks, or prejowl sulcus, or those with age-related atrophy of the dorsal hands are candidates for treatment with what filler?
calcium hydroxylapatite (CaHA)
- CaHA also has been used with success in the correction of atrophic acne scars, in the recontouring of nasal defects, and in nipple reconstruction after failed nipple areolar reconstruction
- Because of the risk of nodule formation, CaHA is not recommended for lip augmentation and should be used judiciously in the periorbital area.
it is the filler of choice for patients with** collagen vascular disease or proven allergic reactions to collagens or hyaluronic acids**
Autologous fat transfer (AFT)
- There are a subset of patients in whom AFT is not indicated. These patients include those with very low body fat, such as long distance runners, the elderly, and those with HIV-associated lipodystrophy, patients on concomitant anticoagulant treatment, and those who are of poor health
Viscosity of silicone oil is measured in what unit of kinematic viscosity?
centistokes (cs)
Tumescent Anesthesia Solution
most devastating complication associated with the use of all fillers
Vascular occlusion
- This can manifest as local necrosis, CNS infarction, or blindness
- Blindness and middle cerebral artery infarction have been described most often after fat transfer, but vascular occlusion with ensuing sequelae has occurred after the use of collagen and hyaluronic acid fillers as well.
- Other complications common to the use of all fillers include ecchymosis, edema, extrusion or drifting of the filling substance, foreign-body reactions, pigmentary alteration, injection site scarring, overcorrection, undercorrection, misplacement, and infection.
