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Aesthetic Training - Revision > Dermal Filler > Flashcards

Dermal Filler Flashcards

1
Q

What organisation approved the use of Hyaluronic Acid (HA) Dermal Filler?

A

The US Food and Drug Administration (FDA)

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2
Q

What does Dermal Filler do?

A

Adds volume and also stimulates the body to create more of it’s own collagen.

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3
Q

What is Hyaluronic Acid and what are the advantageous for it’s use as a Dermal Filler?

A

It is a naturally occurring substance that is already found in the skin to keep it plump and hydrated. Results are temporary and can last between 6-12 months.

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4
Q

What additional ingredient is found in many HA fillers?

A

Lidocaine, which provides some anaesthesia to minimise discomfort.

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5
Q

List the main FA and UK approved Dermal Fillers.

A

Juvederm
Restylane
Belotero Balance

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6
Q

What are the commons causes of lines and wrinkles?

A

Volume loss in the skin (e.g. sleeping on one side of the face), skin laxity due to aging, rapid or significant weight loss and serious disease.

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7
Q

When are a persons lips at full capacity?

A

Age 16 for boys and girls.

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8
Q

What are some causes of lip aging?

A

Smoking, exposure to hot and cold, licking of the lips, cold sores and some medications and illnesses.

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9
Q

What would you recommend to a client to alleviate or minimise bruising after Dermal Filler procedure?

A

Applying Arnica gel for a few days.
Avoid Aspirin
Avoid exercise and alcohol for the first 48hrs
Ice the area for a few minutes each day

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10
Q

How long is a bruise likely to last if trauma has occurred as a result of the procedure?

A

2-5 days depending on the clients own body and their healing ability.

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11
Q

Explain what Aspirate means and why it is recommended before injecting Dermal Filler, where possible?

A

The process involves pushing the needle through the skin as normal, but then instead of immediately pushing the plunger down to release the fluid or medication, the user should pull the plunger up and hold it like that to create negative pressure for anywhere from 5 to 10 seconds.

This is done as a safety measure to ensure that you are not inadvertently injecting fluid into a blood vessel. Therefore no blood should be sucked up. If it does, stop and use a different needle to go again.

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12
Q

How old do we consider someone to be to have mature skin?

A

25

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13
Q

List 4 contraindications for treatment.

A
  • Neuromuscular disorders (E.g. ALS, Multiple sclerosis, Muscular dystrophy).
  • Hypersensitivity to the product.
  • Infection is present where you want to inject
  • Pregnant/ breastfeeding (not approved by the FDA but little information so it’s a precaution due to a pregnant women’s body changing due to hormones but no evidence of any negative impact to baby just unpredictable results for the mother)
  • Under 18
  • People on blood thinners for a long time (it’s recommended to be off blood thinners 2 weeks prior to treatment but must consult with Dr before stopping any prescribed blood thinners).
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14
Q

What medications should clients avoid prior to dermal filler treatment?

A

Herbal supplements and anti inflammatory medications have a blood thinning effect and should therefore be avoided a few days before treatment. E.g. St.Johns Wart, Aspirin

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15
Q

What are some common mistakes when administering dermal filler?

A
  • Insufficient filler (but also go cautiously as you can use the top up appointment)
  • Poor expectation management of the client e.g. highlight any natural unevenness and implication for filler before treatment
  • Not sharing the syringe equally in the zone of treatment
  • Injecting above the line of a fold which will make it look worse
  • Not considering the impact of other facial muscles on the area of treatment/ concern, or second order implication (e.g. filling too close to the facial part and looking like the nose is stuck on the face or like someone has food in their mouth).
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16
Q

What are the three injection techniques for volume loss?

A
  • Fanning (even spread)
  • Layering (for severe volume loss)
  • 90 degree supports (if tissues is significantly displaced by gravity)
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17
Q

What are the three injection techniques for surface creases and volume loss?

A
  • Serial puncturing (mild surface lines)
  • Cross hatching (90 degree supports to help resist gravity)
  • Linear threading (inject directly under and along the line)
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18
Q

When does filler appear lumpy?

A

Too much filler. Massage area to smooth out.

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19
Q

What is the cupids bow?

A

The central part of the upper lip with the two peaks.

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20
Q

What is the vermillion border?

A

The demarcation from the epidermis (normal skin), which is highly keratinised and the red part of the lip, which is less keratinised.

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21
Q

What is the pink skin on the lips called?

A

Vermillion

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22
Q

What is atrophic lips?

A

Loss of lip volume (soft tissue) in the lips as part of aging)

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23
Q

How many injections are used for the lips and how are they positioned?

A

Central part of the vermillion - make sure to stay way from the wet border. Never inject in the central part of the lips.

[A technique but not recommended: Six linear threads injections for the upper lip border; Five for the lower lip border]

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24
Q

What size needle do you use to inject lip filler?

A

30 gauge 1/2 inch needle (13mm)

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25
Q

Describe how you inject the filler (where, what angle etc.)?

A
  • Prepare the needle by depressing the syringe plunger until a small amount of dermal filler extrudes the tip of the needle
  • Insert the needle into the vermillion border at an angle of 30 degrees
  • Inject the filler as you withdraw the needle
  • Start at the outer edge of the lip and move inwards towards the cupids bow (the needle must end at the tip of the cupids bow).
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26
Q

What do you do once you’ve injected the filler into the lips?

A

Compress the area gently with the thump and massage to smooth out any visible bumps of filler.

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27
Q

What direction do you massage the lip border post-filler injection?

A

Medial to lateral.

28
Q

How deep do you inject dermal filler into the lip mucosa?

A

2-3mm

29
Q

What is lip swelling called and how long does it past after lip filler?

A

Lip edema; it lasts a few days after treatment and is normal.

30
Q

Why would the first part of the injected lip look larger than the other when even amounts have been injected?

A

Due to the quick onset of lip edema. You can be confident if you know you’re injected the same amount of filler on each side.

31
Q

What are the side effects of lip filler?

A

Swelling
Bruising
Necrosis
Herpes simplex

32
Q

What is Occlusion of the lips and how do you treat it?

A

When the therapist has injected into or near the artery causing blood flow to be reduced or stop. Treated by:
- Massage
- Applying heat to the area to promote blood flow
- Inject enzyme to break down the substance e.g. Hyaluronidase
- Take aspirin to thin blood

33
Q

What is a hematoma?

A

A large bruise under the skin. It will heal on it’s own but can be use a cold compress to help it heal.

34
Q

What is embolism and what does it lead to?

A

When filler has been injected into an artery. It can lead to severe implications leading to blindness etc.

35
Q

How do you try and resolve an embolism?

A
  • Massage
  • Heat
  • Hyaluronidase
  • Aspirin
36
Q

What is Necrosis?

A

Death of body tissue

37
Q

What causes Necrosis?

A

Embolism of an artery or compression

38
Q

How can you minimise the risks of dermal filler causing complications?

A
  • Know the anatomy well
  • Inject it in small amounts (less than 0.1ml)
  • Inject it slowly
  • Don’t inject any deeper than is necessary
    -Keep an emergency pack to hand.
39
Q

What is the fold called between the bottom edge of the nostrils and outer corner of the mouth?

A

Nasolabial or Melolabial folds

40
Q

Where are the Marionette lines?

A

The fold going down from the corner or the lips

41
Q

What are the wrinkles called in between the eyebrows?

A

Glabellar wrinkles

42
Q

Where is the mentolabial crease?

A

The top arch of the chin part way between the lips and bottom of the face

43
Q

What are the two types of wrinkles called?

A

Dynamic - deeper from muscle movement
Static - external factors like smoking or ageing

44
Q

What are the three different types of fillers?

A
  • Temporary biodegradable (6 - 12m)
  • Semi permanent biodegradable (1 - 2yrs)
  • Permanent non-biodegradable (2+yrs)
45
Q

Do you need a prescription for dermal filler?

A

No

46
Q

Do you need a prescription for botox?

A

Yes

47
Q

Where do you place dermal filler in the upper cheek?

A

Against the bone because the arteries are superficial. But always aspirate!

48
Q

Can you reuse the filler in the syringe with a new needle on a new client?

A

No! This is due to the risk of cross contamination when you aspirate.

49
Q

Can you re-use botox in a syringe with a new needle for the next client?

A

Yes. This is because the botox in the syringe hasn’t been exposed so there is not risk of cross contamination (you don’t aspirate with botox)

50
Q

How deep should filler be in the vermillion (lip)?

A

Less than 3mm deep in the dry border of the vermillion.

51
Q

If filler is appropriate for the brow and glabella area (usually treated with botox), where do you inject the filler in the skin?

A

In the dermal layer of the skin.

51
Q

What must you ALWAYS do before injecting dermal filler?

A

Aspirate for up to 10 seconds.

51
Q

What is the main risk when injecting filler into the glabella region?

A

Vision and tissue loss.

51
Q

What layer of the skin do you inject filler into the temporal region?

A

In the superficial subcutaneous tissue (fat layer), just below the dermis.

52
Q

How can you check that you have the needle in the correct layer of skin before injecting?

A

Lift the needle to make sue it doesn’t show white (this is too superficial) but that it is only skin.

53
Q

How deep should you inject dermal filler into the infraorbital region?

A

Inject superficially and laterally. Do not perform deep injections in this area.

54
Q

Where do you inject dermal filler into the nasolabial fold?

A

In the lower two thirds of the fold (not in the upper crease because the nose will look stuck on).

Inject in the deep dermal layer or superficial subcutaneous layer.

55
Q

Why is the risk reduced if we inject the nasolabial fold in the deep layer pf the skin?

A

This is due to the facial artery course mainly running beneath muscle or above it but in deeper planes of the face.

56
Q

Why is it advised to avoid injecting dermal filler into the lower two thirds of the nasolabial fold?

A

Because the facial artery can become more superficial in this area. This could be de-risked with aspiration but recommended for advanced practitioners.

57
Q

Should you inject dermal filler into the nose?

A

No! This is high risk due to the shallow nature of the vasculature of the nose.

58
Q

What is the most common technique to inject dermal filler?

A

Tunnelling technique, which is safer and required the needle to be injected at an angle of 30 or 45 degrees.

59
Q

How/where is the filler injected when the needle is in the skin?

A

Dermal filler is only injected as the needle is slowly removed; this is called retro-trace or retrograde filler.

60
Q

Why is dermal filler not recommended in the upper face?

A

It has an unacceptable degree of risk due to the vast array of blood vessels. Do not inject dermal filler into the glabella or for crows feet. Use botox.

61
Q

What area of the periorbital region (around the eye) can have filler injected?

A

Tear trough and the eyebrow but this require a specific type of filler and careful administration. This is an advanced procedure and using a cannula technique is advised.

62
Q

How do you know if the needle is too superficial in the skin?

A

You will see the needle under the skin and a whitening effect.

63
Q

What should you do immediately after injecting dermal filler?

A

Massage the area to smooth out any irregularities.

64
Q
A

Aesthetic Training - Revision (8 decks)

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