Treatment areas

Question 1

1. Forehead muscle target

Answer 1

Occiptofrontalis - frontalis fibres

Question 2

1. Brow ptosis risks

Answer 2

Hyperkinetic frontalis patients
Female
Short forehead
Lid laxity
Hooded eyelids

Question 3

1. ‘Mephisto’ ‘Spock’ look

Answer 3

Undesired wrinkling of lateral forehead from undertreatment of lateral fibres

keep lateral injection point 1cm from temporal fusion line

Question 4

1. Lateral injection point for glabella

Answer 4

female - mid pupillary line for brow lift
male - lateral corner of eye

Question 5

1. Treating high forehead

Answer 5

Second line can be placed close to hairline

Question 6

1. Forehead dose & injection points

Answer 6

10-20 units, 5 points

Question 7

2. Glabella line muscle targets

Answer 7

Procerus
Depressir supercilii
Corrugator supercilii

Question 8

2. Glabella dose & injection points

Answer 8

20-40 units
3-5 injections

Question 9

2. Glabella anatomical landmarks for injection

Answer 9

1cm above orbital rim

Question 10

2. Complications of Glabella treatment

Answer 10

Eyelid ptosis - diffusion of toxin to levator palpebrae

treated with 0.5% aproclonidine eyedrops

medial brow drop if placed too high into frontalis

Question 11

3. Brow lift aim

Answer 11

Lift lateral eyebrow
Upper eyelid fullness/hooding
Improve sad/tired look
Address descent of aging

Question 12

3. Brow lift muscle target

Answer 12

lateral fibres orbicularis oculi
frontalis

Question 13

5. Gummy smile

Answer 13

Escessive gum show during smile or laugh, inversion of upper lip whilst smiling

Question 14

5. Muscle targets for gummy smile

Answer 14

Raise and evert the upper lip

Levator labii superioris alaeque nasi

Levator labii superioris

Zygomaticus Minor

Triangle formed by these three muscles

Question 15

5. Gummy smile dose and injection areas

Answer 15

Below the level of orbicularis oris lateral to pirifrom apeture

or 3-5mm lateral to each nostril

Prominent nasiolabial fold - one injection per side 2-4 units targeting LLSAN

Flat nasolabial fold and longer lips - one injection per side targeting LLSAN and LLS 1-2 units

Question 16

5. Gummy smile injections, prominent vs flat nasiolabial folds

Answer 16

Inject lower with flat nasiolabial folds and longer upper lip

Question 17

1. Correcting medial brow ptosis

Answer 17

See if there is residual medial corrugator activity

treatment can restore some lift

Question 18

2. Glabellar injection depths

Answer 18

Procerus - half needle

Medial corrugator - full needle (supraperiosteal attachment)

Lateral corrugator - upper third

Question 18

Crows feet treatment complications

Answer 18

Diplopia - lateral rectus

Zygomaticus muscles - disrupt the smile

Dry eyes - lacrimal gland affected by deep superior injections

Malar oedema - loss of lymphatic drainage from sphicter action

Question 19

Dangers of treating infra orbital lines

Answer 19

Risk to intraocular muscles

corneal abrasions if eye closure is affected

Local malar oedema

pseudoherniation of infraorbital fat pad

Question 20

Dangers of nasalis treatment

Answer 20

2-4 units per side

infiltration into origin of levator labii superioris

affecting lip elevation/smile appearance

Question 21

Injection points and dose for smokers lines

Answer 21

Targeting orbicularis oris

Up to 4 injection point placed superior to vermillion border

1-2 units per point

2.5-5 SU

Question 22

Cautions when treating smokers lines

Answer 22

Articulation changes

Intstrument playing

Straw drinking

Upper lip lengthening (lip flip)

Question 23

Muscles that can accidentally be treated during smokers line treatment

Answer 23

LLSAN

zygomaticus minor

Question 24

Mentalis - injections and dose

Answer 24

4 units or 10SU Directly into muscle - midline injection 1.5cm away from lower lip 2 points may be necessary for wider square chins

Question 25

Cautions when treating mentalis

Answer 25

Avoid depressor labii inferioris - lateral avoid orbicularis oris - superior

Question 26

Depressor anguli oris - injections and dose

Answer 26

2 units or 5 SU approx 1cm lateral and inferior to the corner of the lip superifical plane

Question 27

Cautions when treating depressor anguli oris (3)

Answer 27

Too deep will hit the depressor labii causing smile assymetry stay medial to anterior border of buccinator muscle

Question 28

Platysmal bands - injections and dose

Answer 28

2 units or 5SU per point, do not exceed 40 units unlicesnsed indication points 2cm intervals along bands

Question 29

Cautions when treating platysma (4)

Answer 29

cannot correct excess loose skin or fat deep injection or too much product will cause dysphagia can affect the layrnx neck flexion via the sternocleidomastoid

Question 30

Bunny lines - injection and dose

Answer 30

2 units or 5SU the pars transverse portion of the nasalis superficial single point lateral to nose bridge

Question 31

Cautions when treating nasalis

Answer 31

Origin of levator labii superioris - smile assymetry

Question 32

Masseter - injection and dose

Answer 32

20 units or 50SU injection placed .5-1cm from each border of safe zone 2-4 injections

Question 33

Safe zone for masseter ijection

Answer 33

anterior - anterior border of masseter posterior - posterior border of masseter inferior - inferior endge of mandible superior - imaginary line from mouth corner to ear lobe

Question 34

Cautions of treating the masseter (5)

Answer 34

chewing weakness asymmetry paradoxical bulging from not treating superfical and lateral planes in harmony paralysis of marginal mandibular nerve asymmetric smile - risorius

Question 35

Hyperhidrosis - injection and dose

Answer 35

prepare 100 units in 4ml 50 units per side intradermal injections 1-2cm apart 62.5 SU units per side. 125 units in 0.63ml

Question 36

Hyperhidrosis target

Answer 36

Eccrine Sweat glands - cholinergic

Question 37

How to prep the axilla

Answer 37

iodine starch to delineate areas of highest sweating