botox, fillers, lasers

Question 1

Botox is -
and mechanism of action
derived from:
how long does it last
when to first notice effect?

Answer 1

Botulinum toxin A
mech: - inh the release of acetylcholine at the neuromuscular junction of nerve terminals causing temporary paralysis of the muscles

derived from clostridium botulinum type A

lasts 3-6 months and is based on the new axonal sprouting and new SNAP 25 production (where the acetylcholine is stored)

as early as 48 hours will see effect and peak effect is at 14 days.

other botox are minor variations ie disport is abobotulinumtoxin

Question 2

what is botox approved for/not approved for via the FDA

Answer 2

approved for glabellar rhytids (procures and corrugated)
- crows feet by lateral orbicular oculi
- forehead lines with frontalis
ages 18-65

off label: eyelid, nasal, cervical, and peri oral areas

Question 3

contraindications for botox

Answer 3

myasthenia graves - autoimmune antibody against…?
als (amyotrophic lateral sclerosis)
Multiple sclerosis - demyelination of…?
Eaton Lambert syndrome
(look up these diseases?)

Question 4

evaluation for botox

Answer 4

PMH: diseases contraindicated
blood thinning meds- excessive bruising
dynamic wrinkles (will not help with static wrinkles at rest)
ptosis - frontalis injection could worsen
take before and after photos

Question 5

how to reconstitute Botox?

Answer 5

allergen botox
stored at 2-8 degrees Celsius,
- once open use within 4 hours
reconstitute with sterile preservative free saline. stir, do not mix vigorously
2.5 mL per 100 U vial
4 U per 0.1 mL

Question 6

how to inject botox

Answer 6

1) clean skin
2) inject into the muscle except crows feet (obicularis oculi) is injected into the subnormal areas
inject 2 cm above the eyebrow to prevent ptotic brow
peri-orbital injections are placed at least 5-10 mm from the orbital rim and 5mm medial and lateral to the supraorbital nerve.
do not touch or scrub the area.
forehead is 2-4,
glabella is 5-7
crows feet 3-5 U
per injection site.

Question 7

complications of botox

Answer 7

bleeding hematoma
levator of eye spread - can cause ptosis temporary
inability to close eye
diplopia if spreads to intraocular muscles
botulinum effecting the lacrimal gland - block acetylcholine release, diminished tear production.

Question 8

what are different types of filler and mech/how do they work

Answer 8

Hyaluronic acid - repeating dissacharid of glucoronic acid and n acetylglucosamine
- binds 100 x its weight in water
- lasts 6-12 mo
can be reversed with hyaluronidase

calcium hydroxyapatite filler - lets 9-18 months.

Question 9

complications of fillers

Answer 9

Tyndall effect - skin takes on a blue-ish hue after injection, can tx with 15-50 U of hyaluronidase

Tissue necrosis due to vascular (injection/compromise?) (blanching?)- nitro paste, asa 325 sublingual, prednisone 40 mg for 5 days. if HA used can use hyaluronidase (but people allergic to bee stings cannot use hyaluronidase…?). consider HBO.

Volume irregularity - massage, additional filler or hualuronidase if able

blindness - highest risk in the glabella region, hyaluronidase if able and referral to ophthalmologist

herpes simplex activation - prophylactically treat them

foreign body granuloma - chronic inflammatory reaction, tx with hyaluronidase or intralesional corticosteroids.

Question 10

how do you know when you are in the subdermal plane for filler injection.
what are the techniques for injecting filler

Answer 10

when you can no longer see the bevel of the needle
serial puncture - multiple insertion points.
linear threading - one insertion point

Question 11

what does LASER stand for?
MAC?
what effects the LASER?

Answer 11

LASER is
Light
Amplification by
Stimulated
Emission of
Radiation

MAC - stands for Micro Ablative Colums

influences on the laser -
- the energy
- spot size
- fluency
- pulse duration
- power
- density

Question 12

CO2 lasers and Er:YAG laser
wavelength, minimal fluence, pros and cons

Answer 12

CO2- wavelength - infrared wavelength of 10600 nm
minimal fluence - is 4 j/cm2
higher risk of thermal damage

er:YAG laser - infrared radiation at a wavelength of 2940 nm.
minimal fluence - is 0.5 j/cm2
lower risk of adjacent thermal damage but higher risk of bleeding.

Question 13

chemical peels:
skin layers
depth of chemical peels/skin layers

Answer 13

answers is the figure 6.16 in the oral boards review book (page 164)

the stratum basal is at 0.08 mm
I think the thickness of a 15 blade is 0.15 (which includes the papillary dermis when doing a skin graft)

into the papillary dermis is 0.45 mm
dee is the upper reticular to mid reticular dermis - .6 -0.8 mm deep