Injectable soft tissue augmentation Flashcards
What two areas are particularly dangerous/susceptible to vascular adverse effects from filler?
The glabella and perinasal
How long prior to filler injection should vitamin E and non-essential platelet inhibitors be held?
10-14 days
Which fillers cause “blue nodules” in the skin and why are they blue?
HA-fillers and they are blue due to the Tyndall effect
How can nodules/granulomas from fillers be treated?
Intralesional steroids or hyaluronidase for HA fillers
What treatment should be done for painful blanching or necrosis from occlusion from a filler?
Hot/warm compress, tapping the area, topical nitroglycerin, injection of hyaluronidase (if HA filler)
Occlusion of which vessels by filler can cause blindness?
Suprotrochlear or supraorbital arteries –> can lead to occlusion of the central retinal artery
Which fillers had the highest risk of anaphylaxis?
Bovine collagen (Zyderm/Zyplast). These are now off the market
Needed two negative skin tests prior to treatment
What is polymethacrylate (ArteFill) and how long does it last?
Permanent filler for deep wrinkles made from polymethacrylate suspended in bovine collagen
What must be done prior to using polymethacrylate filler?
Skin testing 30 days prior to procedure
Where is the injection of polymethacrylate targeted for?
Deep dermis
What are the uses of calcium hydroxyapatite (Radiesse) filler?
Deep wrinkles, HIV lipoatrophy, hand rejuvenation
How long does calcium hydroxyapatite (Radiesse) filler last?
9-18 months
Which filler can be seen on X-ray?
Calcium hydroxyapatite (Radiesse) filler is radio opaque
What is the primary use of Poly-L-lactic acid (Sculptra)?
HIV lipoatrophy and deep wrinkles
How long does Poly-L-lactic acid (Sculptra) last?
9-18 months
What is the “rule of 5’s” for Poly-L-lactic acid (Sculptra)?
For massaging in the product –> 5 minutes at a time, 5 times a day, for 5 days
If nodules/papules are seen after injection of Poly-L-lactic acid (Sculptra) what happened?
Didn’t inject deep enough, needs to be a deep injection
What component of a hyaluronic acid (HA) fillers contribute to the strength of the filler?
Only cross-linked hyaluronic acid, free HA does not contribute
What is the importance of crosslinking of HA for HA fillers?
Natural HA is degraded rapidly, crosslinking makes it more resistant to breakdown, thus the higher the % of crosslinking, the longer it lasts
What is the G’ of a filler?
The elastic modulus, the higher the number the more volume support is offered (if you were to put it on a table, higher G’ leads to less spreading of the puddle)
What is the effect of a HA filler with a higher G’?
More volume support after injection
What is the viscosity of a filler?
This is the resistance to flow, the higher the viscosity the harder to push through the syringe
What anatomic area should not be injected with calcium hydroxyapatite (Radiesse)?
The lips
Which fillers are painful and often needs to be mixed with lidocaine?
Calcium hydroxyapatite (Radiesse), restyle/Restylane-L, Perlane/Perlane-L, Juvederm,
What is an indication for autologous fat transfer for cosmetic purposes?
Large volume that needs to be filled
What is an important disadvantage of autologous fat transfer?
Less predictable effects, unclear how much of the fat will take and mature
How long do most HA fillers last?
6-12 months
Which filler is made from rooster comb?
Hylaform (HA filler) [Only lasts 3-4 months]
Which HA filler has the highest G’?
Perlane
Which HA filler has the lowest G’?
Juvaderm Ultra
