Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Level 7 Exam > Dermal Filler Complications > Flashcards

Dermal Filler Complications Flashcards

1
Q

What are the IMMEDIATE signs that can occur post dermal filler?

A

Vascular occlusion
Anaphylaxis
Bleeding, bruising
Vasovagal
Skin changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the EARLY signs that can occur post dermal filler?

A

Infection
Swelling + oedema
Nerve damage
Placement related e.g. nodules
Undesired muscle change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the LATE signs that can occur post dermal filler?

A

Hypersensitivity related swelling/oedema
Inflammatory nodules
Late chronic infection/biofilm
Product migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give a rough outline of the course of the facial artery

A

Starts deep anterior to masseter muscle.
Runs tortuous course in deep plane and becomes more superior towards alar base.
Gives off superior and inferior labial
It lies deep in the plane beneath modiolus and becomes intermediate in nasolabial fold.
Courses medial cheek near nose as angular artery and enters orbit to anastomose with ophthalmic branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Can you give a brief description of the superficial temporal artery.

A

It is the terminal branch of external carotid artery. Supplies lateral forehead, temple, zygoma and ear.
Gives off frontal branch which leads towards superior lateral orbital rim which eventually anastomoses with supraorbital.
It also gives off transverse facial anteriorly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What artery do the supratrochlear and supraorbital branch from?

A

Internal carotid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What arteries emerge from foramina?

A

Supraorbital
Infraorbital
Mental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is anterograde vs retrograde embolism?

A

Anterograde is when movement of emboli is in direction of blood flow
Retrograde is when it moves in the opposite direction to blood flow`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of immune reaction is anaphylaxis?

A

IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is usually the first sign of anaphylaxis?

A

Skin or mucosal changes
e.g. urticaria, erythema, hives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms associated with anaphylaxis on an A-E assessment?

A

A - tongue swelling, coma, airway swelling, hoarseness, stridor
B - rapid breath, wheeze, cyanosis, spO2 reduced, confusion
C - pallor, clammy, low BP, tachycardia, faintness, drowsy, coma
D - sense of impending doom, decreased consciousness
E - skin changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should you manage anaphylaxis?

A

Lie patient flat and raise their legs (if no airway compromise).
Adrenaline 1:1000 0.5mg IM
High flow oxygen and cardiac monitoring
Repeat every 5 mins and up to 3 times, if no improvement transfer to acute care setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should adrenaline be used for anaphylaxis?

A

If there are severe features such as respiratory difficulty or hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the typical timeline of a vascular occlusion?

A
  1. Pain and blanching in seconds
  2. Livedo reticularis in minutes
  3. Purple discolouration in minutes to hours
  4. Blisters and pustules in hours to days
  5. Eschar in days to weeks
  6. Healing in weeks to months following
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you manage a vascular occlusion?

A
  1. STOP injecting
  2. Conservative measures first = firm massage for 5 mins, warm compress, firm tapping over occluded area
  3. Hyaluronidase within 4hrs of treatment - small volume high concentrate protocol (1500IU in 1-2mls) and monitor capillary response every hour in clinic
  4. Aspirin 325mg STAT to limit platelet aggregation and clot formation
  5. Seek expert advice (debridement, specialist dressings)
  6. Follow up with regular daily F2F reviews with detailed documentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of retinal artery occlusion?

A

Nausea, headache, ophthalmoplegia, ptosis, enophthalmos, pupillary dilatation, horizontal strabismus (due to affecting extraocular muscles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What locations are maximum risk for retinal occlusion?

A

Nose
Glabellar
Forehead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which areas are severe risk for retinal artery occlusion?

A

Tear trough
Temple
Nasolabial
Medial cheek
Periorbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Once the retinal artery is occluded, how long is there until blindness is irreversible?

A

12-15 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How should you manage a suspected retinal artery occlusion?

A

Seek expert emergency ophthalmological care
In the meantime you can:
- assess visual loss
- decrease IOP (ocular massage, have patient breathe into bag to increase blood CO2, consider SL GTN)
- basic neurological assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If a haemorrhagic area is palpable what is this known as?

A

Haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is tyndall effect?

A

Blueish hue visible within skin if HA is placed too superficially.
It will often look like an innocent bruise which does not resolve.
Usually prevented by using small amounts of filler at an appropriate depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some of the ways you can manage placement issues (e.g. overcorrection, asymmetry, Tyndall, migration, malar oedema)?

A
  1. Massage to disperse (if superficial)
  2. Do nothing!
  3. Aspiration - can be done early for small papules/nodules
  4. Hyaluronidase - large volume protocol
  5. Additional filler - if concern is symmetry (can be done 2wks after dissolving)
  6. Colour correction for Tyndall if do not want any intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you prevent a vasovagal?

A

Manage pain control
Reassure verbally
Encourage deep breaths
Have lying down for treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What individuals are prone to hyperpigmentation?

A

Fitzpatrick skin type IV to VI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you manage hyperpigmentation?

A

Topical hydroquinone
Isotretinoin
Chemical peels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you treat neovascularisation?

A

Laser treatment

27
Q

What bacteria normally causes acute skin infection? e.g. cellulitis or erysipelas

A

Staphylococcus aureus

28
Q

What is an abscess?

A

Pus in confined tissue space
Presence of fluctuance will determine management options

29
Q

What is a biofilm?

A

It is a peptidoglycan envelope barrier which confers resistance to antibiotic penetration and cultures are often negative

30
Q

What can precipitate biofilm formation?

A

Low immunity
Dental infection
Trauma
Iatrogenic manipulation

31
Q

How can we as injectors prevent biofilms?

A

ANTT
Avoid injecting swollen/infected areas
Reducing entry points
Using small needles

32
Q

How do you treat skin infection caused by bacteria?

A
  1. Analgesia, flucloxacillin 500mg QDS PO (or clarithromycin 500mg BD PO)
    2nd Line = addition of co-amox/ciprofloxacin
    I+D if abscess forms and fluctuant
    Hyaluronidase once initial infection is treated
33
Q

What does rapid onset oedema within first 2 weeks suggest?

A

Type 1 mediated swelling (IgE)

34
Q

What are risk factors for malar oedema?

A

Periorbital swelling on waking
Presence of malar bags
Previous botox to lower orbicularis oculi

35
Q

What treatment factors increase risk of malar oedema?

A

Superficial injection
High volume filler
High G prime
High hygroscopy of products

36
Q

How should malar oedema be managed?

A

If occurring within first 2 weeks it should be managed conservatively as may settle down in a short time
- Avoid steroids, consider hot/cold treatments, gentle massage for lymphatic drainage
- if after 2-3 weeks these measures fail then hyaluronidase may be used and steroids for resistant cases

37
Q

What is neuropraxia?

A

Physiological block without axonal disruption
Deficits should improve within days to weeks (6-8 weeks)

38
Q

What is axonotmesis?

A

Anatomic disruption of axon with little disruption to endoneurium meaning regeneration can occur over weeks to months

39
Q

What is neurotmesis?

A

Severe anatomic disruption of axon where full recovery unlikely

40
Q

What are the 5 branches of the facial nerve?

A

Temporal
ZYgomatic
Buccal
Mandibular
Cervical

41
Q

What do each branch of the trigeminal supply?

A

V1 Ophthalmic = supraophthalmic, supratrochlear, external nasal and lacrimal
V2 maxillary = infraorbital, zygomaticotemporal and zygomaticofacial
V3 mandibular = buccal, mental and auriculotemporal nerves

42
Q

What are the symptoms of a non-inflammatory nodule?

A

Cool, firm, with a discrete regular surface

43
Q

How do you treat an immediate non-inflammatory nodule?

A
  1. Firm massage
  2. Aspiration if small
  3. Rule out infection
  4. Can use hyaluronidase BUT do not use is an suspect of infection
44
Q

How do you treat resistant/delayed non-inflammatory nodules?

A
  1. Mechanic methods and intralesional hyaluronidase can be repeated
  2. Should also consider infective/inflammatory nodules if they persist
45
Q

What is usually the cause of inflammatory nodules?

A

Result of infection (biofilms) or foreign body granulomas
which is why those with active autoimmune disease are not ideal candidates

46
Q

What are the signs of an inflammatory nodule?

A

Pain, tenderness, induration, warmth or redness
If it is fluctuant then consider abscess

47
Q

What are granulomas?

A

Rare histological diagnosis
- red form papules/nodules/plaques in subdermal part of skin which appear within 6 months of treatment
- more likely after injection with products that don’t biodegrade (unlike HA)

48
Q

How do you treat inflammatory nodules?

A

Usually abx over months rather than weeks
MONOTHERAPY: macrolide (clarithromycin 500mg BD) or tetracycline (minocycline 100mg BD) for 2 weeks.
- if improves but not completely gone then continue for 4 wks
DUAL THERAPY: macrolide (clarithromycin), tetracycline (minocycline/doxycyline) and/or quinolone (cipro)
- if no improvement after 4 weeks of dual therapy consider hyaluronidase (do this monthly until resolved)

49
Q

How should hyaluronidase be stored?

A

Cool temperatures to last longer (2-8)
If stored at 25 degrees then it lasts approx 12 months
Once opened discard any unused contents

50
Q

How does hyaluronidase work?

A

Hydrolyses endogenous and implanted HA by cleaving beta-1,4 linkages

51
Q

What is the time of effect of hyaluronidase?

A

Immediate
Half life of 2-10 mins
Duration of action 24-48hrs
Inactivated in kidneys and liver

52
Q

Can hyaluronidase permeate through vascular walls?

A

Yes

53
Q

What is the difference in steps for emergency vs non-emergency use of hyaluronidase?

A

Emergency = no patch test, small volume protocol (1500IU in 1-2mls saline), serial punctures along course of obstructed artery

Non-emergency = do intradermal patch test followed by large volume low concentration dilution (1500IU in 10mls saline)

54
Q

What is the time gap that should be between hyaluronidase and botox use?

A

Botox can be administered 48hrs after hyaluronidase

  • this is because hyaluronidase makes tissues more permeable and encourage toxin spread
55
Q

What is the process for intradermal patch testing?

A

Large volume protocol - injection of 30 units (0.2mls) into forearm recommended
- pre and post photographs
- keep for observation and check for 30 mins

56
Q

What is a positive reaction for patch testing?

A

Wheal and flare
Increase by 50% size
Wheal increase by over 8mm size

57
Q

When might you need higher doses of hyaluronidase?

A
  1. High HA concentration
  2. High amounts of crosslinking
  3. Previous use of multiple products
  4. Nodules
  5. Injected over 6 months ago
  6. Use of poor quality product
58
Q

How do you reconstitute hyaluronidase?

A

Add 1ml of dilutent to opened ampoule of hyaluronidase and ensure powder is fully dissolved
Aspirate the 1ml of reconstituted hyaluronidase to the remaining solution
Agitate solution to ensure completely mixed

59
Q

How much hyaluronidase should be used per 1ml filler? (non-emergency)

A

30 units per 1ml

60
Q

What are the steps for administration of hyaluronidase?

A
  1. Consent 2. Inspect 3. Clean
  2. Technique (30G needle or cannula serial punctures)
  3. Depth 6. Whether there is VO
  4. Firm massage to disperse product and apply warm compress
  5. Assess response: check cap refill, skin colour and absence of pain
    Repeat these steps if required hourly until resolution of ischaemia
    Aftercare = remain at clinic for 30-60 mins after, give written and verbal aftercare and contact details
61
Q

What is the (i) medial (ii) lateral lymphatic drainage routes?

A

(i) medial = submandibular nodes
(ii) lateral = parotid nodes

62
Q

What are the signs and symptoms of salivary gland injury?

A

Symptoms = Pain and tenderness in the
salivary gland region
Signs = Swelling fluctuating with food intake
Discharge from wound
Facial paresis or paralysis

63
Q

Symptoms/signs wise, what is the difference between herpes simplex and herpes zoster?

A

Simplex = bilateral vesicles over dermatome
Zoster = unilateral vesicles over dermatomal distribution

64
Q
A

Level 7 Exam (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions