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tox Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the action of botox when injected into the muscle

A

neurotoxin purified protein derivative of clostridium botulinum bacteria that blocks the release of acetylcholine at the neuromuscular junction. This results temporary reduces muscle contractions and smooths skin wrinkles in the treatment area.

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2
Q

what causes wrinkling to be a prominent feature of skin aging

A

the skin naturally thins and loses volume over time as collagen, hyaluronic acid, and elastin gradually diminish. this process of dermal atrophy is accelerated and compounded by sun exposure and other extrinsic factors such as smoking, and excessive movement of facial muscles.

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3
Q

what contributes to skin folds and facial contour changes

A

skin laxity, redistribution of facial fat, and biometric changes such as bone resorption

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4
Q

when was botox first used

A

in the 80s indicated for blepharospasm and strabismus

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5
Q

when was botox approved for upper face muscles

A

2002

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6
Q

what are the basic tox treatment areas

A

the upper third of the face.
frown lines, crows feet, and horizontal forehead lines

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7
Q

what are considered advanced tox treatments

A

the lower face because this is a highly functioning region and must retain partial functionality and essential function for eating, drinking, speaking, breathing

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8
Q

who will see the most dramatic improvements with tox treatments

A

patients with dynamic wrinkles that have minimal to no static component

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9
Q

what will the results look like of patients with static wrinkles

A

slower and cumulative, and may require two to three consecutive treatments for significant improvements

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10
Q

who may not fully respond to tox treatments and need a combination treatment of dermal fillers or resurfacing procedures

A

people with deep static lines

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11
Q

at what age may require surgical intervention instead of tox treatments

A

age 65, because they may have severe static wrinkles and laxity

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12
Q

what are the alternative therapies other than botox

A

for static wrinkles include chemical peels, microdermabrasion, topical retinoids, non ablative lasers, ablative and fractional lasers

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13
Q

what are the contraindications of botox

A

pregnant or nursing
active infection in treatment area
keloidal scarring
bleeding abnormality
immunocompromised
skin atrophy
active psoriasis/eczema in area
allergy to albumin, lactose, sodium succinate
milk allergy with dysport
gross motor weakness in treatment area
neuromuscular disorder
inability to actively contract muscles in treatment area
periocular or ocular surgery within 6 months
medications such as ahminoglycosides, penicillamine, quinine, calcium channel blockers

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14
Q
A

how is botox stored

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15
Q

how is botox stored

A

unopened vials must stay refrigerated as well as when opened. once reconstituted it should be used within 6 weeks

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16
Q

patient friendly terms for
toxin
paralyzes
pain

A

natural purified protein
relaxes
discomfort

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17
Q

aftercare of tox treatment

A

avoid lying flat for 4 hrs
no facial massaging or pressure and no activities that will cause facial flushing like heat to face, exercise, alcohol consumption, and tanning

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18
Q

what are the 20 muscles of the face

A

frontalis
temporalis
procerus
corrugator supercilli
depressor supercilli
orbicularis occuli
nasalis
levator labi superioris alaque nasi
levator labi superioris
zygomaticus minor
zygomaticus major
orbicular oris
modeolus
risorius
platysma
depressor anguli oris
depressor labi inferioris
mentalis
buccinator
masseter

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19
Q

what are the 14 superficial muscles of the face

A

frontalis
temporalis
procerus
depressor supercilli
orbicularis oculi
nasalis
levator labii superioris alaque nasi
zygomaticus minor
zygomaticus major
orbicularis oris
modeolis
risorius
platysma
depressor anguli oris

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20
Q

what are the 7 deep muscles of the face

A

corrugator supercilli
levator labii superioris
buccinator
levator anguli oris
masseter
depressor labi inferioris
mentalis

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21
Q

what muscle form horizontal forehead lines

A

frontalis

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22
Q

what muscle forms frown lines

A

glabellar complex (procerus, corrugator supercilli, depressor supercilli)

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23
Q

what muscle forms crows feet

A

orbicular oculi

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24
Q

what muscle forms bunny lines

A

nasalis

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25
Q

what muscle forms nasolabial folds

A

levator labii superioris alaque nasi

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26
Q

what muscle forms radial lip lines

A

orbicularis oris

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27
Q

what muscle forms marionette lines

A

depressor anguli oris

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28
Q

what muscle forms chin line/orange peel

A

mentalis

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29
Q

what is the surface anatomy of the face

A

glabella
nasion
nasal ala
philtral columns
cupids bow
vermillion border

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30
Q

what is the action of the corrugator supercilli

A

draws eyebrows medially

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31
Q

what is the action of procerus and depressor supercilli

A

medial eyebrow depressors

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32
Q

what is the action of the frontalis

A

eyebrow levator

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33
Q

what is the action of the orbicularis oculi

A

lateral eyebrow depressor

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34
Q

what is the action of the superior orbicularis oculi

A

superior lateral eyebrow depressor

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35
Q

what is the action of the nasalis

A

draws nasal sidewalls medially

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36
Q

what is the action of the orbicularis oris

A

lip puckering

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37
Q

what is the action of the depressor anguli oris

A

corner of mouth depressor

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38
Q

what is the action of the levator labii superiors alaque nasi

A

central lip levator

39
Q

what is the action of the mentalis

A

chin puckering and lower lip levator

40
Q

as we get older why do our eyebrows change

A

the height of our eyebrows can change do to change in frontal fat pads (lowering)

41
Q

when injecting corrugator supercilli how should we inject

A

inject deeper medially, getting more superficially as you get to the lateral part of brow

42
Q

why should you always treat the glabella when treating the frontalis

A

because if not the frontalis is relaxed when injected and it will give the look of an angry face when brows are not treated

43
Q

why is the depressor supercilli not directly treated

A

it is not usually a powerful muscle, but when treating the corrugator supercilli you are also treating the DS.

44
Q

if the patient is still pulling down with the medial brows even if you think you treated well before, what should you try next

A

try treating more superficially because the depressor supercilli is above the corrugator supercilli

45
Q

medial muscle at bridge of nose that pulls the glabella down

A

procerus

46
Q

why wouldn’t you treat the procerus with same amount of units on everyone

A

this muscle is variable because some people have a very meaty procerus and others don’t

47
Q

what type of dose would someone get with a meaty procerus and downward pull is seen

A

higher units in procerus than someone who doesn’t seem they pull down from procerus, but instead the corrugators

48
Q

what muscle runs very close to the surface of the skin around eyes

A

obicularis oculi

49
Q

when treating only the lateral canthal lines what may you see

A

a medial pull under the eye because the outside portion has been relaxed

50
Q

since the face is like a tug of war, frontalis muscle is pulling up and orbicularis oculi is pulling down, if you relax the OO what do you get

A

you can get a lift in the brow, can even be a brow treatment for a brow ptoosis

51
Q

why would you not want to over treat and inject deeply in the orbicularis oculi

A

the orbicularis oculi is an accessory muscle for cheek elevation, if over treated you could look less genuine. improve technique by injecting more superficially and this will remove the risk of hitting zygomaticus and also do not inject too inferiorly

52
Q

when injecting the frontalis of a male why would we not treat them like we would a female

A

men seem to have a taller forehead and they could get “horns” at the top right and left from no treatment higher up

53
Q

recommended dose for frontalis

A

12-20 units women
20-25 units for men because muscle strength

54
Q

recommended dose for glabellar complex

A

10-24 units women
20-25 units men

55
Q

recommended dose for crows feet

A

10 units per side women
10-12 units per side men

56
Q

recommended dose for lower eyelid

A

2.5 units total bilateral
typically 0.5 unit each injection

57
Q

recommended dose for eyebrow lift

A

5-7 units total bilateral (women)
7-10 units total bilateral (men)

58
Q

recommended dose for bunny lines

A

5-10 units total bilateral

59
Q

recommended dose for lip lines

A

3.75-5 units total bilateral

60
Q

recommended dose for gummy smile

A

2.5 units total bilateral

61
Q

recommended dose for marionette lines (DAOs)

A

5 units total bilateral

62
Q

recommended dose for mentalist (chin)

A

5 units total

63
Q

what is the supraorbital ridge

A

the brow ridge, bony ridge located above the eye socket

64
Q

what is the lateral limbus line

A

boundary between the lateral iris and the sclera

65
Q

what is the orbital rim

A

outer edges of your eye socket

66
Q

what is the midpupil line

A

line directly below pupil when looking straight

67
Q

what is the lateral canthal line

A

lateral (outside) corner of eye

68
Q

what is the nasion

A

where top of nose starts

69
Q

what is the nasion-ala line

A

line on side of nose from nasion to nasion ala

70
Q

what is the lateral canthal line

A

invisible line from outside corner of eye directly inferior to jaw

71
Q

what is the nasolabial fold line

A

invisible line from nasal ala diagonal to jaw (follows formation of nasolabial fold)

72
Q

what is the chin circumference

A

round area of chin with the highest point at the mental crease reaching to the mandibular margin

73
Q

what is the mandibular margin

A

chin/ front jaw line

74
Q

what is the oral commissure lines

A

invisible line from outside corners of mouth that go inferior to clavicle

75
Q

safety zone of frown line (11s)

A

at least 1cm above supraorbital ridge at the lateral limbus line, and extends inferiorly to a point approximately 1cm below glabellar prominence

76
Q

safety zone of horizontal forehead line

A

bounded by vertical lines at the lateral limbus line and includes 2cm above supraorbital ridge to the hairline, and small area lateral to vertical lines approximately 2cm inferior to hairline

77
Q

safety zone of crows feet

A

1cm outside orbital rim, above the superior margin of zygoma and extends under the eyebrow to the lateral limbus line

78
Q

safety zone of lower eyelid

A

medial lower eyelid injection is located mid pupillary line, 0.5cm inferior to eyelid margin
lateral lower eyelid injection is located midway between the first injection and the lateral canthal line 1cm inferior to eyelid margin

79
Q

safety zone of eyebrow lift

A

at least 1cm outside the orbital rim, below the supraorbital ridge and lateral to the lateral limbus line
first injection is located 1.5cm lateral to lateral limbus line (near tail) angling injection toward forehead
and second injection is 1cm medial to first injection

80
Q

safety zone for bunny lines

A

diamond shaped region with superior point of diamond located at nasion and inferior point located halfway through nasion and nasion tip
the lateral points lie along the nasion ala line

81
Q

safety zone for lip lines

A

upper lip= at least 1cm from the lateral corners of the mouth, 0.5cm or less from the vermillion border, and extends to the lateral edge of the philtral column
lower lip= at least 2cm from lateral corners of mouth and is 0.5cm or less from vermillion border

82
Q

safety zone for gummy smile

A

while muscle is contracted (big smile) insert needle in the muscle bulge at the uppermost part of the nasolabial fold. angle needle medially and insert half needle length

83
Q

safety zone for DAOs

A

at least 1cm anterior to the border of the master muscle, posterior to the marionette line and within 2cm of the mandibular margin
while muscle is contracted, insert needle into muscle, at least 1cm inferior to the corners of the lip, angle needle towards corners of mouth

84
Q

safety zone for chin

A

at least 1cm medial to chin circumference and is within 2cm of mandibular margin
inject while muscle is contracted and angle needle towards the lip to tip ends at the chin protuberance

85
Q

how many injections for mentalis

A

one for a narrow/ rounded/ pointed chin
two for broad/ square/ cleft chin

86
Q

where is the mentalist injection located for a narrow/ rounded/ pointed chin

A

one medial injection

87
Q

where is the mentalist injection located for a broad/ square/ cleft chin

A

one point on EACH side of midline

88
Q

how should bunny lines be injected

A

while nasals is contracted inject medial to nasal ala line located on side wall. angle needle towards nasal sidewall and insert subdermally, repeat on both sides
the third injection is on dorsal of nose while contracted approach inferiorly angling needle towards dorm of nose and inject

89
Q

how do you elicit contraction of muscle to be treated for an eyebrow lift (superioris orbicularis oculi)

A

first check to make sure pt has enough muscle to inject by placing finger beneath this portion of muscle and have patient contract, if visible roll is evident, proceed

have patient blink really hard and hold it and mark spots
insert needle while relaxed

90
Q

what test should be performed prior to lower eyelid injection

A

snaptest
pinch skin under eye and let go, if skin recoils immediately the test is normal. if skin recoils longer than 3 seconds the lower lid has insufficient elasticity and should not be performed

91
Q

how should you inject lower eyelid

A

two injections usually performed for each eye. one medially and laterally.
medial muscle is placed with muscle at rest and located mid pupillary line 0.5cm inferior to eyelid margin
second injection is placed during muscle contraction between first injection and lateral canthal line 1cm inferiorly to eyelid margin

92
Q

how should you inject crows feet

A

instruct pt to smile and mark points, inject middle point first, directly above first injection, and then last injection located below first injection

93
Q

how should you inject frown lines

A

inject while pinching muscles, for corrugator muscles inject towards procerus, for procerus inject 90degrees if thick muscle, if not inject inferiorly

94
Q
A

Medical Aesthetic Treatments (8 decks)

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