Filler And Botox Flashcards
Liquid silicon is relatively safe to use.
F. Liquid silicone use was associated with multiple complications such as migration of the material, hepatic granulomas and hepatitis, and even death
demonstrated a posterior and inferior rotation of the facial skeleton and bony remodeling contributing to the loss of midface projection
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Anterograde injection associated with less bruising due to hydrodissection of the planned filler
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Retrograde injection of filler as the needle is withdrawn may minimize the risk of intravascular injection and diminish accessory dissected regions
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stop anti-inflammatory and antiplatelet agents a week prior to
treatment to minimize bruising.
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techniques that produce more epidermal injury (multiple punctures as in serial puncture or cross-hatching techniques) do not seem to increase the occurrence of adverse events.
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reduction in facial expressions for the first 24 hours may be associated with decreased filler material migration and improved patient’s cosmetic outcome
reduction in facial expressions for the first 48 hours may be associated with decreased filler material migration and improved patient’s cosmetic outcome
Both dermal and fascia! grafts have incorporation rates equivalent to that of autologous fat and provide similar duration of improvement
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The type of collagen that need alargec test before using it is zyderm
T. Non autologous biologic filler like bovine collagen ( zyderm) need test becoz of high immunologic reactivity,
HA is equal to or superior to collagen in correcting nasolabial folds for longer periods of time
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Factors affecting viscosity include size and molecular weight of the HA particles
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higher G’ translates into greater tissue lift but smoth feeling
F. higher G’ translates into greater tissue lift but firmer feel.
Higher viscosity is associated with decreased spread of the filler within tissues but also with decreased ease of injection.
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Scalptra is hydrophilic
F. Hydrophobic
Both human collagen products, Cosmoderm (Inamed) and Cosmoplast (!named), and porcine collagen products, called Evolence require skin
testing prior to treatment
F have a low risk of allergic reaction and do not require skin
testing prior to treatment
bovine collagen requires double skin testing
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HAs
do not require allergy testing prior to injection
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HA is equal to or superior to collagen in correcting
nasolabial folds for longer periods of time
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The bovine collagen filler Zyderm (Inamed Corp., Santa Barbara,
Calif.) was the first nonautologous filler to be approved by the
U.S. Food and Drug Administration (FDA).
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HAs are
chemically identical in all species; therefore, no allergy skin testing
is required prior to their use
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Animal-based HA fillers, which are
no longer marketed in the United States, are derived from rooster
combs
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A greater
degree of cross-linking correlates clinically with longer duration of
effect of the filler.
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Viscosity refers to the ability of the gel to resist shear forces
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non-animal-based HAs are derived from bacterial
fermentation of Streptococcus equi
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Why is scalptra not advices to used in the periorla or periorbital area ?
use of the filler in the perioral and periorbital regions may be associated with an increase risk of skin papules or subcutaneous nodules; therefore, caution should be used or treatment avoided in these areas
HAs are equivalent or superior
to human, bovine, and porcine collagen in correcting nasolabial folds
as well as volume deficits at other sites including the dorsal hands
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elastic modulus refers to the ability of the gel to resist deformation
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Polymethylmethacrylate contiane bovine coolagen
T for that reason must undrgo skin testing prior to use
PMMA if it put superficial produce asymptomatic nodules?
F. superficial placement of this product is associated with pruritis, redness, and h yp ertrophic scarring. 3 7 Topical steroid use and intralesional corticosteroid administration may be employed to ameliorate these problems.
the filler effect has a duration of approximately 18 to 24 months which is due to fibroblast stimulation and deposition of type 1 collagen into the areas of PLLA microspheres.
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use of Sculptra in the perioral and periorbital regions may
be associated with an increase risk of skin papules or subcutaneous
nodules; therefore, caution should be used or treatment avoided in
these areas
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PLLA is a hydrophobic compound and requires reconstitution
with bacteriostatic water for a minimum of 3 hours prior to injection.
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Calcium Hydroxylapatite can inject superficial
F this product is highly viscous and deep injection is
recommended.
An injectable acellular dermal graft has been developed and demonstrated to be effective in improving upper lip volume and lower lip projection without local or systemic
complications
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HAs placed too superficially produce small lumps or visible bumps. called the Tyndall effect
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. Delayed nodule formation may be attributed to a granulomatous reaction and occur several weeks after filler injection
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The glabellar region is considered
a high-risk area due to the small caliber of the supratrochlear vessels.
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Measurement to decrease the incidance of intrascaular injection
aspiration prior to injection of the filler material, serial puncture
technique use, antegrade or retrograde linear threading technique
use, skin tenting prior to injection to allow accurate placement
of filler superficial to arterial structures, and manual occlusion of
larger vessels in the treatment zone prior to injection
Fortunately, scarring after filler procedures is rare
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PMMA contains bovine collagen this product is associated with pruritis, redness, and hypertrophic scarring.
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HA and this enzyme is commonly an animal-based preparation
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CaHA placed superficial to the deep dermis appears as white nodules in the skin
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HAs placed excessively
superficial can be managed immediately with a massage to distribute
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Polymethylmethacrylate contains bovine collagen; therefore,
patients must undergo skin testing prior to its use
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CaHA was noted to have significantly better nasolabial fold improvement at 8 months postinjection when compared to several HA fillers and to collagen products
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Can we use antibiotic use after a filler procedure?
Recently, biofilm-producing bacteria have been implicated in the development of delayed-presentation nodules after the use of dermal fillers leading to consideration of antibiotic use after a filler procedure.
Dysport contain lactose
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BoNT does not appear to affect the CNS
BoNT does not appear to cross the blood-brain barrier, but modulatory effects on the central nervous system can occur.
Toxin canot moves to distant palce
F. Migration of the toxin, defined as its movement to distant tissues, can occur either by neuroaxonal transport or hematogenously
centrally acting effect of the toxin has been recorded
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Why the incobotulinumtoxin A is safer than other forms of botox
incobotulinumtoxinA contains only the active 150 kDa neurotoxin responsible for the therapeutic effect
Before using botox for. Upper Extremity Vasospastic Disorders the patient should undergo vascular imaging studies to rule out occlusive disease.
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Onlabel indication of Botox
botulinum toxin uses are glabellar lines and lateral canthal lines (crow’s feet)
Off label use of botox
off-label uses include forehead lines, lateral nasal lines,
perioral rhytids, marionette lines, and platysmal bands
Which drug potentiate the botox effect
Aminoglycosides, penicillamine, quinine, and calcium
channels may potentiate the effects of botulinum toxin;
whereas choloroquine and hydroxychloroquine may
reduce the effects
Absolute contraindications
known hypersensitivity
reactions to any ingredient in the formulation, including
lactose (Dysport) and albumin (all preparations), as well as
preexisting infections at the injection sites
SNARE
proteins are involved in fusion of the synaptic vesicle with the plasma
membrane
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diffusion refers to
the concentration gradient-driven transport of the molecule through
the tissue
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spread portrays the initial extent of injection by the practitioner
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VDiffusion process is mostly complete after
24 hours,
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no differences in diffusion of the toxins have been
observed in vivo
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Spread is a much more controllable factor
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there is reasonable evidence that BoNTA and BoNTE,
injected at therapeutic dosages, undergo retrograde axonal transport from sites of injection to the spinal cord and motor cortex
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four commercially available BoNT preparations
Botox” (OnabotulinumtoxinA, Allergen.
Dysport” (AbobotulinumtoxinA
Xeomin” (IncobotulinumtoxinA
MyoBloc* or NeuroBloc* (RimabotulinumtoxinB
All formulations except incobotulinumtoxinA (Xeomin) contain
complexing proteins.
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Xeomin most stable of the commercially
available preparations (3-4 year shelf life at room temperature
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The glabella region was the first area to be treated with botulinum
toxin for cosmetic purposes
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Risk of ptosis after glabelar injection
eyelid ptosis (about 3%)
The injection sites for this area start in the lateral orbicularis oculi muscle, just temporal to the lateral orbital rim. The other
areas are 1 cm superior and 1 cm inferior with a 30-degree angle
toward the midline.
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injections should not extend inferior to the maxillary prominence.
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The most frequent adverse reactions following injection of botulinum toxin in the lateral canthal region are eyelid edema and bruising
(about 1%)
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The lower treatment
row will be halfway between the superior extent of the frontalis muscle and the eyebrow
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The upper treatment row will typically be halfway between the superior aspect of the frontalis muscle and the lower
treatment row
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The most frequent adverse reactions following injection
of botulinum toxin for forehead lines are headache (9%), brow ptosis
(2%), and eyelid ptosis (2%)
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the standard plane of injection
is intramuscular, subcutaneous injections may be equally effective in
achieving paralysis
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When the central and lateral portions ofthe frontalis are
weakened, there is compensatory contraction of the frontalis muscle directly over the brow resulting in elevation
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Excess gingival display (>2 mm) (Gummy Smile) can be treated with botox
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Hyperactive platysmal bands in the superficial subdermal space can
be visualized and are the target of treatment
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It is well accepted that patients
with excess skin laxity in the neck are not good candidates for this
procedure as they have minimal overall improvement
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How many maneuvers has been used in neck botox injection
patients were injected with botulinum toxin along the inferior
border of the mandible and with the platysmal bands using a mean
dose of 124.9 units (however, some express concern given the high dose needed for effect and the potential risks of dysphagia and salivary gland dysfunction)
Direct platysmal band injection with 20 units of botulinum toxin.
Botox is currently indicated for the treatment of chronic
migraines, defined as at least 15 days per month with headaches that
last 4 hours or longer.
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The recommended dosage is 155 units administered intramuscularly for magriane
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Prior to injection, patients
should undergo vascular imaging studies to rule out occlusive disease. in RF
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50-100 units of Botox
was injected into the palm directed toward the neurovascular bundles of the digits
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absolute contraindications for BoNTs are only two: hypersens1t1V1ty to any BoNT preparation (including any component of the
preparation) and infection at the injection site
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For Botox,
this includes 20 units for glabellar lines, 24 units for lateral canthal
lines, 40 units for forehead lines, 44 units for simultaneous lateral
canthal and glabellar lines, and 64 units
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Migraine doses
The recommended dosage is 155 units administered intramuscularly, divided between seven sites in the head and
neck: corrugators (5 U each side), procerus (5 U), frontalis (5 U each
side), temporalis (5 U each side), occipitalis (15 U each side), cervical
paraspinal muscles (10 U each side), and trapezius (15 U each side)
