Ch. 26 Medical Intervention

Question 1

Introduction to Botox Cosmetics

Answer 1

1. Botox Cosmetics is the product name for abotulinumtoxinA; used since early 1970’s.
2. Used to treat blepharospasm (uncontrolled blinking of the eye), strabism (an eye not pointing straight ahead), lines and wrinkles of the glabella, lip lines, and platysmal bands running laterally on neck.

Question 2

American Society of Plastic Surgeons

Answer 2

1. Reports that Botox Cosmetics is the number one non-surgical procedure
2. More than 5.4 million had treatment in 2010
3. Continues to experience significant market growth
4. Other non-surgical procedures do not come close to these numbers

Question 3

Introduction to Dysport

Answer 3

• Brand name for abotulinumtoxinA
  1. Behaves in same manner as Botox Cosmetics on the nerve endings of the muscle
  2. Three differences:
  
  • Cannot be used with allergy to cow’s milk
  • Greater chance of diffusion or “leakage”
  • Faster onset (results seen sooner)

Question 4

FDA Requirements

Answer 4

1. All neurotoxins are required to show a black box warning stating that significant side effects or deaths can occur if the neurotoxin diffused to unintended areas
2. Warning results from deaths associated with the treatment of children with cervical dystopia (severe muscle spasms of the neck); consent must be obtained

Question 5

Indications for Neurtoxin Therapy

Answer 5

1. Lines and wrinkles in the upper third of the face
2. Following facial cosmetic surgery in the upper third of the face
3. Abdominal muscle hypertrophy in combination with other rejuvenating procedure (dermal fillers or soft-tissue resurfacing)
4. Headaches

Question 6

Candidate for Glabellar Botox

Answer 6

11’s

Question 7

Botox complications and side effects FACTS

Answer 7

1. Botox Cosmetics does not cross the blood-brain barrier, the mechanism in the brain capillaries that is selectively permeable
2. This unique feature keeps Botox Cosmetics at the site it is injected limiting side effects to the muscle site

Question 8

Botox complications and side effects

Answer 8

1. Eyelid and brow ptosis
2. Over-treatment or asymmetry
3. Headaches
4. Flulike symptoms
5. Nausea

Question 9

Reported Botox Reactions

Answer 9

1. Reaction to cervical dystonia (neck muscle contraction, causing head to twist and turn to one side)
   
   • Dysphagia (difficulty swallowing): 19%
   • Respiratory infections: 12%
   • Neck pain and/or headache: 11%
   • Development of blocking antibodies: 1% to 2%
2. Reaction to blepharospasm (involuntary blinking or spasm of the eyelids)
   
   • Ptosis: 20.8%
   • Superficial punctuate keratitis (death of small groups of cells on the surface of the cornea, eyes become red, water, and sensitive to light): 6.3%
   • Eye dryness: 6.3%

Question 10

Complications and side effects of Dysport

Answer 10

1. More limited and relate to cervical dystonia and glabellar treatment
2. Adverse events are limited to less than 5% and include muscle weakness, Dysphagia (difficulty swallowing), dry mouth, injection site discomfort, fatigue, headaches, neck pain, musculoskeletal pain, dysphonia (difficulty speaking), muscle spasms, injection site pain, and eye disorders.

Question 11

Types of dermal fillers

Answer 11

1. Natural products
   
   • Hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid
2. Synthetic material
   
   • liquid silicone
3. Have been called “liquid face-lifts”

Question 12

Hyaluronic Acid

Answer 12

1. “Hyaluronic acid exists in the extra cellular space and functions as a space-filling, structure-stabilizing, and cell-protective molecule.”
   
   • Paul Franki and Ellen Gendler
2. 50% of hyaluronic acid housed in skin
3. Plentiful in eye fluid and joints where it acts as a lubricant and shock absorber

Question 13

Restylane and Perlane

Answer 13

1. Manufactured by Q-Med
2. The differences is the particle size of the gel
3. Both are synthetic hyaluronic acid
4. Both are synthesized from cultures of “Streptococcus equip by fermentation in the presence of sugar, which is alcohol precipitated, filtered, and dried.”
   
   • Hylans and Soft Tissue Augmentation

Question 14

Juvederm and Juvederm Ultra Plus

Answer 14

1. Newest hyaluronic acid gel injectable products intended for fine lines, wrinkles, lip augmentation, and tear through treatment
2. Flows easily with less chance of lumping
3. Does not show through skin
   Continued treatments will sustain results

Question 15

Prevelle Silk by Mentor Corporation

Answer 15

1. Has specific cross-linking to assist with durability
2. Typically used for fine lines at upper lip or glabellar after Botox Cosmetic or Dysport
3. Short-acting hyaluronic acid filler that does not last as long as the more robust fillers, such as Juvederm Ultra Plus or Perlane

Question 16

No hyaluronic Acid Fillers

Answer 16

1. Two types
   
   • Sculptra
   • Radiesse
2. Choices will be focused on client with skin laxity and volume loss
3. Liquid injectable silicone (LIS) remains controversial because it is not FDA approved

Question 17

Sculptra

Answer 17

1. Corrects lines and wrinkles using biodegradable substance poly-L-lactic acid (PLLA)
2. Effective for lipodystrophy (facial wasting) common in people with HIV and AIDS

Question 18

Radiesse

Answer 18

1. Calcium hydroxylapatite suspended in gel
2. Gel made from glycerin sodium carboxymethylcellulose and water
3. Components are hypoallergenic and inert
4. FDA approved for use in vocal cords and urethra, to treat cranial defects, and for cosmetic use

Question 19

Dermal filler side effects

Answer 19

1. A side effect is an unforeseen event with the drug or device
2. Effective management of side effects depends on steps taken before treatment and at earliest stages of recognition of a side effect

Question 20

Dermal filler complications

Answer 20

1. The likelihood of dermal filler complications is rare and can be minimized by taking proactive steps during consultation, treatment, and determination that a complication has occurred.
2. Necrosis occurred when needle is inserted into blood vessel and a drip of filler occludes blood flow to skin, causing skin to die

Question 21

Dealing with complications

Answer 21

1. Communication is key
2. Ensure client is informed of risk and signs consent form
3. Know processes to prevent complications
4. Know who to ask for help
5. Never attempt to correct a medical condition on your own
6. Be compassionate and sympathetic

Question 22

Combining Neurotoxin Therapy and Dermal Fillers

Answer 22

1. Treatment results in 50% improvement in lips
2. When dermal filler is complete, injector may add six to eight units of Botox Cosmetics
3. Space treatments evenly to provide symmetrical results
4. Crow’s feet are often solved with Botox alone; clients with significant volume loss will need dermal filler also
5. Glabella treatment may not always respond without the use of dermal filler

Question 23

Sclerotherapy

Answer 23

Injection of a chemical irritant into the vein that causes fibrosis and, later, elimination of the lumen; it is used to treat varicose veins, hemorrhoids, or esophageal varices

Question 24

Causes of Sclerotherapy

Answer 24

1. Gender: women are twice as likely as men
2. Geographic area: less common in non-Western countries
3. Age: the longer the veins have been pumping, the more likely they are to fail
4. Weight: the more weight, the more likely the venous return system will be compromised
5. Pregnancy, hormone changes, and menstruation

Question 25

Vein Therapy

Answer 25

1. More than 50% of women need Sclerotherapy

2. Some women have pain and larger vessels associated with the disease

Question 26

Esthetician’s role in Sclerotherapy

Answer 26

1. To answer question
2. To determine indications and contraindications
3. Contraindications: HIV, AIDS, diabetes, blood-borne diseases, circulatory problems, heart disease, and those undergoing anticoagulation therapy.

Question 27

Introduction to Medical Peels

Answer 27

1. Chemical peels are treatments using agents that peel layers of skin, refine the skin, and allow newer and healthier skin to present itself
2. Preferred treatment for many signs of aging including fine lines and variations in skin color called dyschromias
3. Can be an individual procedure or a single step in a multifaceted treatment

Question 28

Types of Peeling Agents

Answer 28

1. Each has a specific purpose and each has advantages and disadvantages as a peeling agent
2. Alpha Hydroxy Acids (AHA’s)
   
   • focus on glycolic and lactic in three strengths
     
     • 30,50, & 70%
     • solution usually has a pH of 2
     • indicated for photos age presenting as dyschromia, fine lines, and rough textures

Question 29

Jessner’s Solution

Answer 29

1. Combination of three different acids: 14 % salicylic, 14% resorcinol, and 14% lactic in an ethanol base
2. Increasing salicylic acid will lead to clumping and debris in the the solution
3. Provides a superficial peel solution focusing on exfoliating and digestion of the debris associated with acne

Question 30

Salicylic Acid (Beta) Peel

Answer 30

1. A bet Hydroxy acid (BHA) found in willow bark, though it is manufactured chemically from sodium phenolate
2. Come in strengths from 12.5 to 30%
3. Can cause salicylate toxicity with symptoms such as: headache, dizziness, vomiting, and tinnitus (ringing in the ears)

Question 31

Trichloracetic Acid (TCA)

Answer 31

1. A common peeling agent in medical spas; comes in strengths of 5, 10,15, 20, and 25%
2. Benefits: nontoxic, stable, easy to use, and able to create a variety of results
3. Commonly recognized peel is Obagi Blue Peel, which usually uses 30% TCA; penetrates the papillary dermis or upper reticular dermis when full frost is archived

Question 32

Other Solutions

Answer 32

1. Other important solutions are phenol and pyruvic acid
2. Moses common is Baker-Gordon (BG) solution, which is a combination of phenol, Septisol, and croton oil
3. Combination result is in a 45 to 55% concentration of phenol
4. It penetrates to reticular dermis and coagulates with proteins and gives a frost

Question 33

Trichloracetic acid (TCA) peels

Answer 33

1. Flatten scarring
2. Reduce rhytides
3. Correct photo damage
4. Improve hyperpigmentation
   * Does Not: reduce pore size, eradicate all rhytides, remove telangiectasias, or remove deep scarring

Question 34

Jessner’s solution and AHA/BHA peels

Answer 34

1. Reduce rhytides
2. Correct photodamage
3. Improve hyperpigmentation

*Does Not: reduce pore size, eradicate all rhytides, remove telangiectasias, or remove deep scarring

Question 35

Benefits of Medical Peels

Answer 35

1. Acceleration of natural skin cell replacement
2. Stimulates epidermal growth
3. Causes necrosis (destruction of damaged skin)
4. Induces production of new collagen

Question 36

Contraindications, Complication, and Side Effects of Medical Peels

Answer 36

1. Excessive telangiectasia
2. Infections
3. Rashes and open lesions
4. Sunburns
5. Recent facelift or eyelid lift
6. Accutane use within previous year

Question 37

What are the two sides of Esthetics?

Answer 37

1. Esthetics Side
   
   • microdermabrasion
   • facial toning
   • esthetic peels
2. Medial Intervention
   
   • Botox cosmetics
   • dermal fillers
   • injection vein therapy