FPRS Implants and fillers Flashcards
Which botulinum neuromodulator serotype demonstrates the longest duration of effect?
Serotype A (90 to 120 days)
What is the mechanism of action of BOTOX?
BOTOX prevents presynaptic neurosecretory vesicles from
docking/fusing with the nerve synapse plasma membrane
(degrades the SNAP-25 protein) and releasing acetylcholine
into the neuromuscular junction.
Vertical glabellar furrows are most likely caused by
which muscle?
Corrugator supercilii
What muscle arises in the medial end of the orbit/
nasal prominence and interdigitates with the
orbicularis oculi muscle laterally and the frontalis
muscle superiorly?
Corrugator supercilii
What medication can be given to patients who develop botulinum toxin-related blepharoptosis,
and what is its mechanism of action?
● Apraclonidine eye drops. An α2-adrenergic agonist,
which causes Müller muscle to contract.
● Phenylephrine can be used when apraclonidine is not
available.
A patient does not appear to have further benefit
after repeated botulinum toxin injections. What is
the most likely cause?
Formation of neutralizing antibodies rendering resistance to
the paralytic effect of the toxin. Often responds to
switching to an alternate type.
What muscle may be treated with botulinum toxin
to decrease the “peau d’orange” or dimpled chin
appearance with facial animation?
The mentalis muscle
What is the role of fillers in scar revision?
To provide bulk to bring a depressed scar level with surrounding normal skin
List examples of tissue-derived injectable fillers?
● Bovine collagen (Zyderm, Zyplast)
● Human particulate “dermal matrix” (Cymetra)
● Cultured autologous fibroblasts (Isologen)
List examples of implantable soft tissue fillers.
● Human acellular dermis (AlloDerm)
● Porcine acellular dermis (Surgisis)
List examples of synthesized selective bioactive
(resorbable) injectable fillers.
● Calcium hydroxyapatite particles (Radiesse)
● Polylactic acid particles (Sculptra)
What is an example of an implantable synthetic
polymer?
Expanded polytetrafluoroethylene (Gore-Tex)
Which implant particle size is not readily phagocytized by macrophages?
20 to 60 μm. Particles smaller than this have been shown to
precipitate a chronic inflammatory response, whereas
larger particles cannot be easily phagocytized and therefore
elicit minimal inflammatory reaction.
What are the challenges associated with the use of
polymethylmethacrylate?
The final phase of polymerization is associated with an exothermic reaction that can cause tissue injury. It can become loose with time despite immobilization. The need for implant removal is higher if in contact with nasal or
frontal sinus tissue.
What is the primary advantage of dermal fat grafts
over free adipose grafts?
There is less resorption than with free adipose grafts,
although even up to 70% of dermal fat grafts are resorbed.
