Filler And Botox Flashcards by M A

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

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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Retrograde injection of filler as the needle is withdrawn may minimize the risk of intravascular injection and diminish accessory dissected regions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

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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,

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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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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.

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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

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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

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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

elastic modulus refers to the ability of the gel to resist deformation

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.

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

PLLA is a hydrophobic compound and requires reconstitution with bacteriostatic water for a minimum of 3 hours prior to injection.

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

HAs placed too superficially produce small lumps or visible bumps. called the Tyndall effect

. Delayed nodule formation may be attributed to a granulomatous reaction and occur several weeks after filler injection

The glabellar region is considered a high-risk area due to the small caliber of the supratrochlear vessels.

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

PMMA contains bovine collagen this product is associated with pruritis, redness, and hypertrophic scarring.

HA and this enzyme is commonly an animal-based preparation

CaHA placed superficial to the deep dermis appears as white nodules in the skin

HAs placed excessively superficial can be managed immediately with a massage to distribute

Polymethylmethacrylate contains bovine collagen; therefore, patients must undergo skin testing prior to its use

CaHA was noted to have significantly better nasolabial fold improvement at 8 months postinjection when compared to several HA fillers and to collagen products

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

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

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.

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

diffusion refers to the concentration gradient-driven transport of the molecule through the tissue

spread portrays the initial extent of injection by the practitioner

VDiffusion process is mostly complete after 24 hours,

no differences in diffusion of the toxins have been observed in vivo

Spread is a much more controllable factor

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

four commercially available BoNT preparations

Botox" (OnabotulinumtoxinA, Allergen. Dysport" (AbobotulinumtoxinA Xeomin" (IncobotulinumtoxinA MyoBloc* or NeuroBloc* (RimabotulinumtoxinB

All formulations except incobotulinumtoxinA (Xeomin) contain complexing proteins.

Xeomin most stable of the commercially available preparations (3-4 year shelf life at room temperature

The glabella region was the first area to be treated with botulinum toxin for cosmetic purposes

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.

injections should not extend inferior to the maxillary prominence.

The most frequent adverse reactions following injection of botulinum toxin in the lateral canthal region are eyelid edema and bruising (about 1%)

The lower treatment row will be halfway between the superior extent of the frontalis muscle and the eyebrow

The upper treatment row will typically be halfway between the superior aspect of the frontalis muscle and the lower treatment row

The most frequent adverse reactions following injection of botulinum toxin for forehead lines are headache (9%), brow ptosis (2%), and eyelid ptosis (2%)

the standard plane of injection is intramuscular, subcutaneous injections may be equally effective in achieving paralysis

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

Excess gingival display (>2 mm) (Gummy Smile) can be treated with botox

Hyperactive platysmal bands in the superficial subdermal space can be visualized and are the target of treatment

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

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.

The recommended dosage is 155 units administered intramuscularly for magriane

Prior to injection, patients should undergo vascular imaging studies to rule out occlusive disease. in RF

50-100 units of Botox was injected into the palm directed toward the neurovascular bundles of the digits

absolute contraindications for BoNTs are only two: hypersens1t1V1ty to any BoNT preparation (including any component of the preparation) and infection at the injection site

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

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)