Cosmetic Surgery Flashcards
What bacteria produces hyaluronic acid for fillers
Streptococcus equi species
Name 4 hyaluronic acid fillers
Restylane
Juvederm
Perlane
Belotero
What is the ratio of Boxtox to Dysport
1:3
What is the brand name of Onabotulinumtoxin-A
Botox
What is the brand name of Abobotulinumtoxin-A
Dysport
How does botox work.
Cleaves SNAP25 in the PREsnaptic neuron preventing acetylcholine release.
What is the brand name of Botulinum toxin B
Myoblox or Neuro/block
What is the difference between Botulinum A an B
Botox/Dysport (A) cleaves SNAP25 in the SNARE complex while Myobloc/Neuroblock cleaves Snynaptobrevin
What is the chemical irritant agent used in sclerotherapy
Chrom alum Glycerin FDA approved but off label
What is an hyperosmotic agent that is used in sclerotherapy.
Hypertonic Saline 18-30% FDA approved for abortions off label for sclerotherapy.
Name four detergents used in sclerotherapy
Sodium tetradecyl sulfate FDA approved
Polidocanol FDA approved
Sodium Mortuate FDA approved
Ethanolamine oleate FDA approved (mostly varices)
What is Deoxycholic acid
Kybella a bile acid used to treat sub mental fat.
How many Deoxycholic acid treatments do you need.
3 to 6 one month apart. 2mg/cm2
What are the 3 S’s in the SNARE complex
Syntaxin
SNAP-25
Synaptobrevin
at what concentration does TAC peel give frosting
20%
how do assess depth of penetration of a TCA peel
Frosting
how long must you wail to assess TCA frosting
5 minutes
At what concentration does TCA penetrate to the papillary dermis
35% Below 30% is only epidermal penetration.
At what concentration of TCA do you get reticular dermal penetration
50% or higher
What causes the frosting in a TCA peel
denaturation of protien
Name three ways to increase the TCA peel depth of penetration.
repeated application
pretreat with Jessners
abraid skin first
what are the three levels of frosting with TCA
light reticular
confluent with erythema
solid without erythema
What are the four elements that increase longevity
to hyaluronic acid fillers
particle size bigger longer lasting
G’ elastic modulus the higher the more long lasting
cross links higher the more long lasting
concentration
% of haluronic acid in mg/ml is made of what
The free HA (solubilized) + insoluble … free HA is metabolized quickly
What peel requires neutralization with either sodium bicarb or h20
Glycolic acid peels
What filler can be seen with regular x-ray
Radiesse
Fillers not seen on regular x ray can sometimes be seen on what study
CT and MRI
At what level do you inject Radiesse?
dermal subQ junction
Where is on place you should not inject Radiesse? and why.
lips, granulomas
Which lasts longer Radiesse or Voluma
Voluma 2 years Radiesse 15 mos
what chemical is gore tex and or soft form
polytetrafluoroethylene
How long does gore tex last
permanent
the poly lactic acid filler is named what
Sculptra
how long does sculptra last compared to HA fillers
twice as long
what fillers are glycoaminoglycans
hyaluronic acid fillers
what level is sculptra injected at
upper Sub Q layer
what is the interval of sculptra injections
4-6 weeks
Cosmoderm is made of what
collagen
How long does collagen (Cosmoderm) last in the skin
2-4 months
What is Belotero
Hyaluronic acid filler used for fine lines & superficial rhytids lasts 6 months
Hyaluronidase may cause allergic rxns to those allergic to what?
Bee and wasp stings, Hyaluronidase is found in venom of wasps and bees and may be responsible for allergic rxns from the stings.
what can be used prior to a peel and for how long to prevent post inflammatory hyperpigmentation
2% hydroxychloroquine for 4 weeks prior to the procedure and or retin A up to one wk prior to peel
how long should retinoic acid be stopped prior to a peel
1 week, use before this can help get a more uniform peel
what is a brody peel
35% TCA + solid CO2
what % of people develop auto antibodies to Botox making it less effective.
3%
What drugs can enhance the effect of Botox
aminoglycosides (micin antibiotics), Ca channel blocker (Cardizem -Diltiazem/ Procardia-Nifedipine , cyclosporine, anticholinergics (atropine)
besides Glycolic acid what other peel requires neutralization
Pyruvic acid peel
How long should you wait to neutralize a Glycolic or Pyruvic acid peel. and what should you neutralize it with?
when clinical endpoint of erythema is reached at 2-4 minutes with water rinse or 10% sodium bicarbonate solution. If no erythema then neutralize no later than 5 minutes.
Jessner’s solution is what formula
Resorcinol 14 gm
Sal Acid 14 gm
lactic acid 14 gm
Ethanol added to 100ml
Modified Jessners solution replaces Resorcinol with what?
8% citric acid
how do you prep the skin prior to a Jessners peel
degrease with alcohol then acetone scrub
What is one nice side effect of Botox regardless of treatment site
Mood improves
what component of the Baker Gordon phenol peel is responsible for the depth of penetration
croton oil (is a keratolytic)
what is the freeze thaw time
the freeze time + the thaw time total time
what is the temperature of liquid nitrogen
-196 centigrade
What fillers need a skin test x 2 two wks apart
Artefill, zyplast, zyderm (all made from bovine collagen) 2% of those neg first test become allergic
What is Hylaform known as
Restylane
The hyaluronic acid in Hylaform
Rooster comb
Of the three classes of sclerosants what is the only class approved by the FDA Detergent, Osmotic Irritant
Detergent
What is the osmotic sclerosant and how does it work
23% Hypertonic Saline (half that for 1mm veins or less) it works by dehydrating and denaturing the endothelial cells
What is the irritant sclerosant?
Glycerin (Chrom alum glycerol)
what sclerosant is most likely to cause ulceration
23% Hypertonic Saline
what sclerosant is most likely to cause cardiac problems
Sodium Morrhuate
What sclerosant is most likely to cause venous thrombosis
polidocanol
how do detergent sclerosants work?
They denature edothelial cells
Name four detergent sclerosants
polidocanol
Sodium tetradecyl sulfate STS
Sodium Morrhuate
Ethanolamine Oleate
Which sclerosant is most likely to give an allergic reaction
STS Sodium tetradecyl sulfate
When do you do HSV prophylactic treatment for chemical peels.
- Superficial peel not needed unless there is a HSV hx
- Mid strength day before or day of for 7 days
- Deep peel/laser resurfacing day before or day of for at least 10 days.
damage to what organ can be caused by phenol peels?
phenol
Name one absolute contraindication for Liposuction
Pt’s desire to use it as a weight loss technique
What is the newest toxin for glabellar wrinkles?
Jeuveau (Prabotulinumtoxin A)
How does Prabotulinumtoxin work
It is a type A toxin and cleaves SNAP25
What is the conversion of Botox to Myobloc
1:40
What is the conversion of Botox to Xeomin and Jeuvaue
1:1
why does liposuction help with bromhidrosis and Hyperhidrosis
Some Sweat glands and Apocrine glands are located in the Sub Q fat and subsequent fibrosis in the dermis reduces the sweat.
Is excessive scarring in the treatment area an absolute contraindication for liposuction or a relative contraindication.
absolute.
Name four absolute contraindications for liposuction.
weight loss
untreated psychiatric disorders
dysmorphic syndrome
excessive scarring in the treatment area
what is the maximum volume to be removed with tumescent liposuction
4500cc
why is it better to use punch biopsy openings for the cannula than 11 blade slits
they want the holes to remain open in the immediate post op period to reduce edema and bruising
what is the difference between pitting and non pitting edema
pitting edema is due to water, non pitting edema may be due to hypertrophic fat from lymphedema and may be amenable to liposuction treatment
Why would you not use Bupivacaine in tumescent liposuction in place of Lidocaine?
Because of it’s cardiotoxic effects in larger doses.
What are four contraindications for microneedling?
History of keloids
Current infection bacterial or herpes
Immunosuppression
Active acne in treatment area
The half life of Hyaluronic acid is about 24-48 hours how is it broken down.
Hydrolysis into CO2 and water
In Jessners solution contains what that may cause ochronosis
Resorcinol
What is this condition and what three drugs may cause it?
Ochronosis
hydroquinone
Resorcinol (Used in Jessners solution)
Hexachlorophene (a phenol used in Baker Gordon peels)
What is the size of telangiectasias?
1mm or less
a venulectasia is what size
1 to 2 mm
a reticular vein is what size.
2 to 4 mm
Name three varicosities and their sizes.
telangiectasia 1 mm or less
Venulectasias 1 to 2 mm
Reticular veins 2 to 4mm
What is the treatment for erythema ab lipoaspiration
none only father time
What is the for erythema ab lipoaspiration
too superficial liposuction disrupting the subdermal vascular plexus
what is the maximum dose of Lidocane with epi in tumescent liposuction?
55mg/Kg or 8 x the normal maxium for skin surgery
what sclerosing agent has some anethetic properties?
polidocanol (think of the lido in the name)
What is artefill? aka Bellafill
dermal filler of bovine collagen mixed with polymethylmethacrylate microspheres
stimulates collage formation
needs a skin test 4 weeks before
lasts 5+ years
What muscle may get deinervated when treating crow’s feet with botox which causes a unilateral drooping mouth.
zygomaticus major
What is the frankfort line when injecting Botox
an imaginary line from the tragus to the infraorbital rim which it is considered safe to inject above.
What muscle creates bunny lines
Nasalis
When might the risorius muscle which affects the corners of the mouth might be accidently injected if you are injecting what muscle.
Masseter Muscle
Make sure you inject the Masseter (for hypertrophy or clenching teeth) in the posterior 2/3 rds as you might affect the risorius in the anterior 1/3
What is Rimabotulinumtoxin brand name
Myobloc/NeuroBloc
If a person does not have a history of HSV do you need prophylaxis for a mid strength peel?
Yes
day before or of extending for 7 days.
