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LVL7 revision > Lower Third - Dermal Filler > Flashcards

Lower Third - Dermal Filler Flashcards

1
Q

Juvederm

A

Volift (body)
Volbella (border)

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2
Q

Teoxane

A

RHA 3 or RHA kiss (volume)
RHA 2 (Hydration)

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3
Q

Filler longevity

A

3-8 months

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4
Q

Rickett’s line

A

Lateral profile

Nasal tip to chin

Upper lip 4mm from line
Lower lip 2mm from line

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5
Q

Natural lip symmetry

A

Upper lip 70-80% of lower lip volume

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6
Q

GK point

A

Peaks of the cupids bow

The Glogau-Klein points, coincide with the philtral columns

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7
Q

White lip

A

Philtral dimple
Philtrum columns/ridges
Melolabial/nasolabial folds, Cupid’s bow
Vermilion border

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8
Q

Da Vinci’s golden ratio

A

1:1.618

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9
Q

White roll

A

White roll is the white line that borders the top of the upper lip - caucasian

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10
Q

Arterial supply

A

Superior labial artery - First 1-2cm run superficially before penetrating deep

inferior labial artery

Layer 4 deep to muscle

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11
Q

Lip tubercules

A

Subcutaneous fat pads within the lip

3 top
2 bottom

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12
Q

Layer 3 in the lip

A

Orbicularis oris

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13
Q

Prognathic mandible

A

jaw protusion

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14
Q

Retrognathic jaw

A

jaw recession

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15
Q

Layer of labial arteries

A

78% submucosal - layer 4
17.5% intramuscular
2% subcutaneous

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16
Q

Vermillion border treatment

A

Generally avoid in young patients

Risk of migration and ledge formation

Superficial retrograde linear threads 0.025ml with needle

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17
Q

Body of lip treatment

A

Width of nose - medial

Tubercule treatment

Layer 2

Bolus, fan and linear threads

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18
Q

Post procedure swelling

A

up to 10 days

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19
Q

Anatomy of the nasolabial fold

A

Begins at nose ala

extends through inferior cheek and the upper lip

straight, convex or concave shape

ends below lateral corner of the mouth

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20
Q

How to assess the nasolabial fold

A

Upright position

assess for volume loss in the midface

is skin fibrosed in the crease

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21
Q

Technique for nasolabial fold filler

A

Linear threads along fold

Fanning in alar-facial groove

Medial fanning with significant volume lost

As much as 0.8-1ml filler

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22
Q

Type of filler for nasolabial fold

A

Mid- to high viscosity

Juvederm Vollure or Voluma

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23
Q

Features that are inappropriate for NF filler alone

A

thick fibrosed skin

severe deficit in the mid midface

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24
Q

Relation of facial artery to nasolabial fold

A

43% of cases within 5mm of NLF

34% of cases artery crosses NLF

then transitions into angular artery

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25
Q

Which layer is the facial artery found in the lower face

A

subcutaneous layer

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26
Q

How does filler cause blindness

A

central retinal artery occlusion

embolisation of filler through arterial anastamosis

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27
Q

Areas for filler in the lower face

A

Nasolabial folds
Piriform fossa
Lips
Marionette lines
Prejowl sulcus

28
Q

What are marionette lines

A

downturning of the angle of the mouth

crease from oral commisure extending to mandible

29
Q

Cannula entry point for nasolabial fold

A

Base of nasolabial fold

30
Q

Lip and peri-oral targets of treatment

A

Smokers lines

Vermillion Border

Philtrum

Lip volume

31
Q

Lip differences between men and women

A

Women - fullness concentrated within width of nose

Men - within width of chin

32
Q

Cannula technique for lip

A

entry point .5cm lateral to oral commisure

Cannula remains in layer 2

33
Q

Natural lip symmetry

A

upper lip 70-80% volume of lower lip

34
Q

Nerve supply to lips

A

maxillary and mandibular branches of trigeminal nerve

35
Q

Muscle which contributes towards marionette lines

A

Depressor anguli oris

36
Q

Aging in the lower third

A

atrophy of the submandibular fat compartments,

dehiscence of the
mandibular septum

leads to descent of
the fat compartments toward the neck.

37
Q

Treatment of marionette lines

A

oral comissure bolus to support lip corners

Cannula in subcutaneous layer

Fanning and retrograde linear threads

38
Q

Volume of filler for marionette folds

A

0.5-1ml per side

39
Q

Mental crease filler

A

Medium g prime, soft filler

Corrects volume loss in depression beteen body of mentalis and lower lip

Needle

40
Q

Layers of the gonial angle

A
  1. Skin
  2. Subcutaneous fat
  3. SMAS
  4. Parotidomasseteric fascia
  5. Parotid gland
  6. Masseter
  7. Mandible
41
Q

Jowl fat pad framing ligaments

A

mandibular ligament anteriorly

masseteri ligament posteriorly

42
Q

gonial angle

A

wider in females

43
Q

Order of treatment in lower third

A

chin - supraperiosteal bolus

gonial angle - supraperiosteal bolus

pre jowl sulcus - supraperiosteal bolus

then subcutaneous treatments

44
Q

gonial angle volume & injection point

A

0.2 - 0.5ml - 1cm into angle

45
Q

chin volume and injection

A

0.2 - 0.3ml

either side of midline

46
Q

pre jowl sulcus volume

A

0.1-0.3 ml

47
Q

labiomental crease cannule entry point

A

tail of crease

48
Q

Where to avoid adding volume in the lower face

A

subcutaneous layer

jowl fat pad - buccal area of the mandible

49
Q

Mental zone - How to treat belnd chin and jowl

A

Chin to mandibular ligament

subcutaneous

cannula insertion point at chin

cannula reaches resistance at mandibular ligament

retrograde linear threads

50
Q

Masseteric zone - Masseteric ligament to gonial angle treatment

A

subcutaneous

insertion at masseteric ligament - posterior border of the jowl

cannula passes across mandibular line to mandible

51
Q

Masseteric zone - Ascending ramus of mandible treatment

A

subcutaneous

insert cannula at gonial angle

injecting upwards

avoiding parotid gland

52
Q

Treatments to define jaw

3 - bone

3 - subcutaneous

A

Chin, pre jowl sulcus , gonial angle

mental zone, masseteric zone (ascending ramus and masseter to gonial angle)

53
Q

How does mental crease form

A

loss of bondy support to mentalis

causing upwards rotation

54
Q

Causes of temple howllowing

A

HIV lipoatrophy

Skeletonisation of the orbital rim

55
Q

Temple needle technique

A

8mm needle

supraperiosteal

45 degree angle, entry behind fronto-zygomatic process

do not aim for full correction to avoid venous congestion

soft filler

56
Q

Temple important structures

A

Superficial temporal artery and vein in the superficial fascia

temporal branch of facial nerve

57
Q

Facial muscles affected my temporal nerve

A

frontalis

orbicularis oculi

corrugator supercilli

58
Q

Temple cannula technique

A

superficial fascia

medium G prime product

hand palpates lateral orbital rim and superior temporal crest to avoid spread of product

massage

58
Q

temple injection after care

A

expect jaw pain - muscle of mastication

temporalis exits beneath SMAS

periosteal is an intramuscular injection

59
Q

Dangers of treating galeal area

A

Should be done with cannula

risk to supraorbital and supratrochlear arteries

supraorbital foramen - inject atleast 1.5cm away

60
Q

Tear trough product selection

A

Teosyal puresense redensity

mixed crosslinked and noncrosslinked

61
Q

Tear trough treatment technique (deep)

A

infraorbital sulcus and area medial to nasojugal groove treated together

25G cannula, entry point 1cm away from end of tear trough

zygomatic space deepto SOOF to restore volume

62
Q

The tear trough
ligament (TTL)

A

a osteocutaneous
ligament

from the maxilla and inserting
into the skin, along the location of tear trough

63
Q

Infraoribital fat anatomy

A

Seperated by oribularis oculi

superficial malar fat pad

deep suborbicularis oculi fat (SOOF)

64
Q

Tear trough treatment technique superficial

A

27G cannula

subcutaneous

entry point - intersection of verticle lateral canthus line to horizontal nasal ala line

65
Q

Filler brow lift

A

Restore volume to retroorbicularis fat pad and sub brow fat pads

inject deep to orbicular occuli

avoiding structures exiting supraorbital foramen

linear thread deposots

LVL7 revision (18 decks)

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