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facial injectables > Botox tx areas + dosage + administration > Flashcards

Botox tx areas + dosage + administration Flashcards

1
Q

off label?

A

means more to the manufacturerer of a drug

ex - allergen manufacturer of botox
- they have submitted for permission to sell botox - can only supply for applications they applied for

so only advertise for those on label applications

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2
Q

off label comes into play when

A

if data supports use of a product in an area - as a clinician you are in rights to use it for that

  • it has to be firmly embedded in science

(people out there that are selling things that arent under knowledge)

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3
Q

off label with scientific bedding?

A

can use for the purposes

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4
Q

factors that influence beauty

A

7 main ones

  1. facial shape - chin, cheeks, symmetry (phi)
  2. forhead height
  3. eyebrow shape
  4. eye size - inner eye distance
  5. nose shape
  6. lips - lenght and heght
  7. skin clarity texture and color
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5
Q

new patient assessment

start by?

A 
start by looking at 
skin quaity
skin laity 
facial fat assessment - full or empty 
muscles - hyperdynamic or iniimate
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6
Q

facial assessment

all angles to look at

A

dynamic vs static rhytids

brow position and contour

muscle hyperactivity

eyelid ptosis

facial weakness - asymmetry

contour defects

lines, creases

patient preferences

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7
Q

dynamic rhytids

A

raise eyebrows and see the lines

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8
Q

static rhytids

A

lines in face - that stay on rest

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9
Q

top 2 procedures

A

botox (7.4 million)

and soft tissue fillers (2.6 million)

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10
Q

avoid when possible - 10 days prior to procedures

A

NOT a deal breaker but could have additional bruising

NSAIDs
ASPIRIN
FISH OIL
OMEGA 3'S 
FLAX SEED OIL
VITAMIN E 
GINGKO BILOBA
LICORICE
COQ10
CAYENNE 
GINGER
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11
Q

post op instructions why???

A

bonta binds to site within 1.5 hours of injection

no facials that day

avoid sun exposure

do not manipulate area for 2 hours

no exercise for 2 hours

make up application per practioners discretion

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12
Q

safety profile

A

used in clinical

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13
Q

safety profile

A

used in clinical since 1970’s

no known lethal dose

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14
Q

human lethal dose?

A

unknown – doses required to cause systemic side effects are difficult to predict

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15
Q

when botox used for dystonias and a lot / higher doses

A

may see some side effects potentiallt

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16
Q

the botox appointment consists of

A

discussion and diagnoisis

pre-treatment phtogrpahs

informed consent

mark injection sites

decide on dosing

prepare botox for injection then inject

post tx instructions

re appoint for follow up (suggests 2 weeks)

expect appointments to last 15-20 minutes

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17
Q

forhead rhytids

A

only the horizotnal bands
- bands go completely across all the way up

galia - all the way up

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18
Q

forhead rhytids treat with?

A

frontalis injection
only the horizotnal bands
- bands go completely across all the way up

galia - all the way up

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19
Q

frontalis muscle

dosing?

A

only elevator of the forehead
inserts in eyebrow skin

elevates brow strongly

elevates eye weakly

botox = 4-25 U
moderatley deep

no standard injection pattern and not common to be bifid - usually uninterupted accros frontal bone

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20
Q

adverse events with frontalis

A

overly smooth artifical appearance

brow ptosis and eyelid ptosis in patients using frontalis as accessory eyelid elevator

only thing that picks it up is frontalis

if tell frontalis to stop lifting

brow complex will fall down more if give too much

treat the glabellar complex as well if treat the frontalis
- can get more ptosis

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21
Q

adverse events of frontalis

A

excessive denervation will cause an OVERLY SMOOTH ARTIFICIAL APPEARANCE

as well as BROW PTOSIS

and eyelid PTOSIS

in patients usin frontalis as an accessory eyelid elevator!

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22
Q

*if botox in fontalis is not distributed laterally

A

peaking of the eyebrows will occur

if it is not distributed laterally enough

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23
Q

peaked brow in men

A

prob didnt get lateral enough with frontalis injection

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24
Q

deep vs hooded eyes

A

can you see palbreal crease?

- more likely deep set eyes

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25
Q

over due frontalis? advantage in

A

as tissue descends - has a place to go

advantage in deep set eyes

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26
Q

glabellar complex muscles + function

A

corrugator supercilii (bilateral)

midline procerus

bilateral depressor supercilli

MAJOR BROW DEPRESSOR

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27
Q

corrugator muslcles

A

corrugator supercilli

wrinkles forhead vertically

see 1’s or 11’s with contraction

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28
Q

procerus muscle

A

aides in pulling skin between eyebrows downwards

HORIZONTAL BANDS / WRINKLES ACROSS BRIDGE OF NOSE

*part of globellar complex

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29
Q

horizontal frowner?

A

vertical muscles -

lines perpinduclar to their name!!

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30
Q

vertical may need more botox where

A

procerus muslce

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31
Q

placement of glabellar complex ON INJECTION

A

iNjection must be 1 cm away from oribital rim

BOTOX 20-30 UNITS

dont use eyebrows as a guide

32
Q

rare adverse events in glabella

A

all side effects disappear completely with time

diplopia, droopy eyelid, tearful eye

eyelid ptosis

  • getting into levator palpebrae muscle
  • if get it behind the eye
33
Q

treatment for eyelid ptosis

A

iopidine .5% apraclonidine

two gtt’s 3-4 times / day for 2-3 weeks

effect seen 30 minutes after administrtion - lasts about 2-3 hours

34
Q

diplopia adverse affect of?

A

rare side effect - spread into muscles of occular movement into the SUPERIOR RECTUS - is the weakened muscle

can have blurred vision

b tox into upper lid through

superior rectus is the weakend muscle *

avoid going too medial!

35
Q

wht to do to avoid adverse outcomes

4 things listed

A

adjust sites and dosages

to aoid lip ptosisi – injection should be distanced from middle segment of upper lid

injection of medial (near nose) lower lid site to be avoided to avoid diplopia or tearful eye

may also require delting injections more than usual, instead of just decreasing dose

36
Q

crows feet fix?

A

injection with obicularis oculi
which closes the eyelids

dealing with orbicularis oculi
action - closes eyelid

37
Q

orbicularis oculi - general + injection site

A

closes eyelids
can pull down lateral brow as well

placement pattern varies from 1-3 sites on average - with 3-12 on each side

38
Q

adverse events in orbicularis oculi

A

lip ptosis - toxin injected below the zygoma and into the zygomaticus major

39
Q

inferior oblique muscle

A

double vision
if too medial on orbicularis oculi

becuse inferior oblique

40
Q

‘brow lift’ deals with

A

superolateral orbcularis oculi

masseter and temporalis

41
Q

superolateral orbcularis oculi

+ finding location

A

browlift
divide eye into quarters

top lateral area is the target

ask patient to squeeze their eyes closed - reveals the superolateral extent of the orbicularis oculi which pulls down brow

1-2 units per side

42
Q

adverse effects of brow lift with superolateral orbicularis oculi

A

most common is bruising

ptosis can occur (levator palpebrae muscle)

43
Q

when to use neurotoxins in masseter and temporalis?

A

recurrent abfractions

veneer delaminations

repeat fracture

also masseter – used cosmetically for slenderizing the lateral face

44
Q

botox never be used for ?? *

A

NOT BE USED AS A FRONTLINE TREATMENT FOR TJ DYSFUNCTION

45
Q

MYOFACIAL PAIN AND TRIGGER POINTS??? use botox?

A

INSUFFICIENT EVIDENCE to support the use of botulinum toxin for MPS or trigger points

get same result when use silane or lidocaine

NOT indicated for this then – except for the MOST REFRACTORY of cases

46
Q

temporalis muscle

A

used to help in brow lift

inserts into coroinioid

elevates and retractes mandible

dosing is 5-15 per side and is a DEEP injection

47
Q

temple layers

A 
I-skin 
II- subcutanoues tissue 
III- superficial temporal fascia 
Fat pad 
V- deep temporal fascia
VI- temporal muscle

have to get through all of them

48
Q

masseter

A

elevation and protraction of mandible

insertion into coronoid process, ramus of mandble

49
Q

where to inject in the masseteric nerve?

side effects?

A

richest arborization of perforating masseteric nerve branches are confined to area V – lower middle thirdd of masseter

soreness at the injection site and asymmetry may occur

10-80 each side

50
Q

thickness in reaching the masseter

A

thick!

so may need a thicker needle

51
Q

parotid relatonship to masseter

A

need to be low and anteriro to the paratid

52
Q

doses of masseter relates to

A

same as use of botox for silaoliathisis

1-75units - allergen type

53
Q

bruxism

A

common condition - 8-31% of population

2 types = sleep and awake

botox use is:
safe
effective
better clinical results than traditional methods

54
Q

risorius muscle

A

horizontal bands east to west

platsyma could be present - horizontal band covering it

55
Q

nasalis

rhytides could occur adversely with?
adverse events if go into nasolabial fold?

placement too lateral?

A

opens and closes nostrils particularly on forced inspiration

placement - lateral aspect of bridge of nose

rhytides could occur adversely become more pronounced after glabellar and orbicularis oculi tx with bonta

adverse - lip ptosis (if go into nasolabial fold) + double vision if placement too lateral

56
Q

types of smiles?

A

1, mona lisa smile
- raises commissures to highest point of smile dominant muscle is the zygomaticus major (most common) (67%)

  1. canine smile - dominant muscle is the levator labii superioris - mid upper lip raised higher than oral commissures (31 %)
  2. full denture smile
    - simultaneous firing of elevators and depressors (2%)
57
Q

excessive gingival display

A

indicated use botox

58
Q

philtrum heigh / labial height??

anything less than 3??

A

philtrum height divided by labial height =3 oe less = WNL

normal

too big - make look masculin

59
Q

levator labii superiorus alaque nasi

injection site

too superficial of llsan

over dosing?

A

dilates nostril and raises upper lip

can help with excessive gingival display

lateral to the nose tip - wide dosing range and 1-5 per side - need to adjust for any present assymmitries that already present

too superficial =no effect

over dosing = too little tooth show

60
Q

adverse events of llsan

A

asymmetry

61
Q

depressor septi nasi

A

may be absent or underdevloped in some individuals

above central / laterals and canines

pulls nasal tip down with smiling

62
Q

depressor septi nasi

A

may be absent or underdevloped in some individuals

above central / laterals and canines

pulls nasal tip down with smiling

63
Q

tpye 1 of depressor septi variations

A

most common

- visible identifiable can be traced to full interdigitation with obicularis oris from origin at medial cural footplate

64
Q

depressor septi nasi wont improve

A

someone with severly ptotic nose with thick sebaceous skin

65
Q

adverse effects of depressor septi nasi

A

a flat upper lip, a droopy upper lip

66
Q

mentalis general

A

wrinkles chin and protrudes lower lip

67
Q

bonta in chin?

A

improves chin esthetics by altering position of potonion in patients with an under prjection and a high ridinighyperactive mentalis muscle

68
Q

depressor anguli oris involved in

A

angle of mouth down

69
Q

adverse events on mentalis
too lateral?
too much?

A

too lateral = affect lower lip height symmetry

too much in deep muscle = affect oral competency

70
Q

4 dots on top 3 on bottom with

A

orbicularis oris

always 7

71
Q

find depressor anguli oris?

A

ask patient to show lwoer teeth with dentition in occlusoin

72
Q

adverse effects of DAO

toxin likely went where

A

aysemmtric smile with inadvertent placement of toxin in depressor labii

73
Q

radial lip lines from which muscle? function of this muscle

A

orbicularis oris

compress lips against anterior teeth - closes and protrudes lips

74
Q

insertion of orbicularis oris?

adverse?

A

4 dots on top 3 on bottom with

needle inserted parallel to vermillion border - a few mm above it and below it

can use a more dilute solution -orbicularis oris
always 7

overdosing? – difficulty forming the sounds p and b (bilabial sounds) + drooling

75
Q

excessive lacrimation can occur when?

A

adverse effect in orbicularis orid muscel if injection too INFERIOR
- due to dysfunction of evacuation of normal tear production by tear duct, situated on edge of lower lid in corner near nose

CHECK FOR SNAP TEST

76
Q

excessive lacrimation can occur when?

A

adverse effect in orbicularis orid muscel if injection too INFERIOR
- due to dysfunction of evacuation of normal tear production by tear duct, situated on edge of lower lid in corner near nose

CHECK FOR SNAP TEST

77
Q

treat downward oral commissures with injection into

A

depressor anguli oris

facial injectables (10 decks)

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