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Questions pratiques de l'Université Montréal > Fillers, Botox, Peels et aesthetique non-chirurgicale > Flashcards

Fillers, Botox, Peels et aesthetique non-chirurgicale Flashcards

1
Q

Name some technical ways to decrease pain during filler injection?

A
  • Small injection needle
  • Slow fluid injection
  • Cooling preparation
  • Injection perpendicular to skin
  • Vibration or flick movement
  • Letting skin fall onto the needle
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2
Q

What are the main characteristics of HA?

A
  • Stiffness (G1)
  • Cohesivity
  • Cross-linkage
  • Viscosity
  • Longevity
  • Absorption
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3
Q

What are some signs of forehead aging?

A
  • Concavity of lower third of forehead
  • Increased forehead lines
  • Flattening of the brow
  • Flattening of the glabella
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4
Q

What are the characteristics of an attractive female brow?

A
  • Starts medially at the orbital rim
  • In line with medial canthus
  • Slants upwards by 10-20 degrees
  • Eyebrow peak = same distance from the head of the brow as the intercanthal distance
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5
Q

What is the safe placement of of filler in the temporal region

A
  • Supraperiostrlal on bone using needle
  • Subcutaenous using microcannula
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6
Q

What is the Tyndall effect?

A

“blue-ish” hue and skin irregularities (ie. Nodules) caused by too much injection of filler in the subdermal plane or in the superficial dermis

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7
Q

How do you manage Tyndall effect?

A
  • Massages
  • Hyaluronidase injection
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8
Q

What is the safest place to inject in the area of the nose?

A

Exactly midline and on periosteum/perichondrium

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9
Q

What causes jowling

A

Caused by descent of of fat and skin relative to the fixed pre-jowl sulcus.

Also partly cause by tissue deflation of adjacent zones such as prejowls sulcus, marionette sone and lateral oral commissure

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10
Q

Describe the features of a balanced lip

A

Distance between philtral coloms = height of lower lip

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11
Q

What are some acute complications of filler injection?

A
  • Oedema
  • Pain
  • Ecchymosis
  • Nerve damage
  • Venous compromise
  • Skin necrosis
  • Blindness (retinal artery through the ophthalmic artery)
  • Ophthalmoplegia
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12
Q

Which areas are most at risk for blindness?

A
  • Nasal dorsum
  • Glabella
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13
Q

What is the mechanism of action of hyaluronidase

A

Dissolves hyaluronic acid into small compound sugar molecules and water

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14
Q

What adjunct treatments to hyaluronidase can be used in the context of filler complications?

A
  • Aspirin
  • Warm compresses
  • Light massage
  • Hyperbaric oxygen
  • Sildenafyl
  • Nitropaste
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15
Q

What are the 3 different injection techniques for fillers

A
  1. Fanning (multiple passes in different direction without withdrawing the needle)
  2. Linear deposition
  3. Crosshatching (evenly spaced grip pattern)
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16
Q

What are the FDA approved uses of Botox

A
  • Overactive bladder
  • Incontinence
  • Headaches in chronic migrane
  • Muscle stiffness
  • Muscular spasticity
  • Cervical dystonia
  • Stabismus/blepharospasms in 12yrs +
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17
Q

What are the FDA approved uses of botox for cosmetic uses

A
  • Moderate to severe Glabella and crowfeet rhytid treatment
  • Axillary hyperhydrosis if refractory to medical treatments
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18
Q

What is the mechanism of action of botox

A
  • Inhibits the release of acetylcholine at the neuromuscular junction
  • Blocks neurostimulation and muscular activity
  • Causes muscle paralysis
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19
Q

What is the main difference between myobloc vs botox?

A

Myobloc has:
- shorter duration and quicker onset
- Greater radius of diffusion
- Higher pain with injection
- Type B toxin

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20
Q

What is the anatomic location of the procerus

A

Originated at the nasal bone and inserts into dermis of the glabella

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21
Q

What causes horizontal rhytids in the glabella region

A

contraction of the procerus

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22
Q

What rhytids is the frontalis responsible for

A

Horizontal rhytids ABOVE the brow

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23
Q

How do you differentiate between levator ptosis and frontalis ptosis?

A

Resolution of forehead rhytids

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24
Q

What causes vertical rhytids in the glabellar region

A
  • corrugator supra-cilli
  • orbucularis occuli
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25
Q

What are some muscle of the face commonly treated with botox

A
  • Procerus
  • Frontalis
  • Corrugator
  • Orbicularis occuli
  • Nasalis
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26
Q

What is the FDA approve dose of botox for the glabellar region

A

20 units

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27
Q

How are botox units measured?

A

1 unit = calculated the lethal intra-peritoneal lethal dose in mice (LD50 in mice)

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28
Q

What is the safe zone for injection in the masseter

A

Below the the transverse line from the earlobe to the corner of the mouth

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29
Q

What medications that potentiate the effect of botox

A
  • Penicillamines
  • Quinines
  • Calcium channel blockers
  • Aminoglycosides
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30
Q

In which patients is dysport contraindicated

A

Patients with lactose allergy

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31
Q

What is the treatment of eyelid ptosis following botox injection

A

Alpha-adrenergic agonist drops - Phenylephrine (stimulate the muller muscle and improves by 1-3mm)

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32
Q

What are the main uses of HA

A
  • Deep rhytids
  • Restore volume
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33
Q

What the optimal depth of injection in the midface

A

Pre-periosteal

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34
Q

Where should you inject fillers in the tear trough area

A

Periostal injection (safe and higher longevity)

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35
Q

How can you reduce your risk of intravascular injection of fillers

A
  • Large bore cannulas
  • Less than 0.1cc per site
  • Avoid high pressure injection
  • Anesthesia with epi (constricts vessels)
  • Good knowledge of anatomy
36
Q

What are the treatment options for nodule formation following calcium hydroxyapatite injection

A
  • Direct excision
  • Observation
  • Needle disruption
    * Does not respond to steroids
37
Q

What would be your filler of choice for HIV replated lipoatrophy

A

Poly-L-lactic acid

38
Q

What is tretinoin

A

Vitamin A derivative

39
Q

What are the main indications for using tretinoin and the recommended dose

A
  • Improves rhytids (only superficial)
  • Corrects dyschromia
  • 0.05-0.01%
40
Q

What are the effects of Vitamin A derivatives?

A
  • Increase quantity of collagen I, III and VII
  • Greater organization of collagen within the dermis
  • Improved organization of elastic tissue
  • Epidermal hyperplasia
  • Increased mucin deposition
  • Decreased melanin
  • Decreased thickness of stratus corneum
41
Q

What is the mechanism of retinoic acid in reducing acne

A
  • Inhibition of AP1 transcription factors
  • Reduces cornesa adhesions in the stratum corneum => reduced follicular occlusion and comedone formation
  • Reduction of protease activity
42
Q

What is the mechanism of action of systemic isotretinoin (acutane)

A

Atrophy of sebaceous glands throughout the body and attenuation of secretion of sebum

43
Q

What are some clinical findings associated with what is salicylic acid toxicity

A
  • Rapid breathing
  • Tinitus
  • Hearing loss
  • Dizziness
  • Abdominal cramps
  • Central nervous system reactions
44
Q

What is the mechanism for neutralization of TCA peels

A

Coagulates and denatures proteins as it penetrates the skin. Can be neutralized with saline. Metabolized in the body in the superficial dermis (can not go systemically)

45
Q

What is the mechanism of action of Phenol croton oil

A

Protoplasmic toxin that disrupts cell walls and denatures protein

46
Q

What are critical steps that must be taken when preforming phenol treatments

A

Cardiac monitoring
Resp monitoring

47
Q

List the types of chemical peels

A

Superficial
○ Alpha-hydroxy (glycolic and lactic acid)
○ Beta hydroxy (salacylic acid)
○ Jessner solution
Medium
○ TCA 20-35%
Deep
○ Jessner with TCA
○ Phenol
○ TCA over 35%
○ Phenol and croton oil

48
Q

Describe the Fitzpatrick classification

A

I: white: always burns, never tans
II: white: usually burns, hard to tan
III: light brown: sometimes burns, tans average
IV: brown: rarely burns, tans easily
V: dark brown: almost never burns, tans very easily
VI: black: never burns, tans very easily

49
Q

Describe the Glogau classification for photoaging

A

I: mild: 28-35: minimal wrinkles, no keratosis, no acne scarring (little makeup)

II: moderate: 35-50: early keratosis, early wrinkling, mild scaring (some makeup)

III: advanced: 50-65: actinic keratosis, telangiectasia, wrinkling at rest, moderate scaring (always makeup)

IV: severe: 60-70: actinic keratosis, skin cancers, severe wrinkling (makeup cakes on)

50
Q

Describe the Obagi Grades of Frosting

A

1: limited to epidermis: cloudy white frost with pink background

2: to papillary dermis: white-coated frosting with erythema strikethrough

3: through papillary dermis: solid white frost with no background erythema

51
Q

What are some common complications of chemical peels

A
  • Herpetic lesion outbreaks
  • Hyperpigmentation
  • Hypopigmentation
52
Q

What is the mechanism of action of ablative laser

A
  • Complete ablation of epidermis and superficial papillary dermis
  • Thermal injury and coagulation through papillary dermis
53
Q

What are some common transient side effects of ablative laser therapy

A
  • Oedema
  • Exudation
  • Crusting
  • Redness

** these are not complications**

54
Q

Name 2 fillers other than HA approved in Canada

A
  • Poly-L-lactic acid (PLLA)
  • Calcium-hydroxy-apatite
  • Polymethylmetacrylate (PMMA)
55
Q

Name 2 functional complications of injecting botox around the eye

A

Ptosis
Diplopia
Ectropion

56
Q

10 Indications fonctionnelles du botox

A
  • Migraines
  • Blepharospasme
  • Strabisme
  • Spasme hemi-facial
  • Bruxisme
  • Tinnitus
  • Dystonie cervicale
  • Hyperhidrose
  • Spasmes vessie, HBP
  • Frey’s
  • Rhinite allergique
57
Q

6 complications des neuromodulateurs

A

-Réaction au site d’injection, ecchymose, douleur
-Céphalée
-Ptose des sourcil, asymétrie
-Acné
-Infection des voies respi
-dysphagie

58
Q

3 antidotes pour les neuromodulateurs

A
  • Apraclonidine
  • Phenylephrine
  • Pyridostigmine

*mais pas de vrai antidote?

59
Q

3 causes de la non réponse au botox type A

A

génétiques
anticorps pré-formés
dose sous-thérapeutique

*essayer autre marque si jamais

60
Q

Contre-indication au neuromodulateurs

A

-infection active
-allergie à un ingrédient (albumine pour les 3, lactose pour dysport)
-grossesse

Relatives : Maladie de la jonction neuromusculaire, médicaments qui diminue la transmission neuromusculaire (Succinylcholine, PNC, BCC, aminoglycosides, quinines)

61
Q

9 caractéristiques d’un injectable idéal?

A

○ Sécuritaire et non toxique
○ Non allergène
○ Réversible
○ Disponible
○ Prédictible
○ Vieillis avec le patient
○ Downtime minimal
○ Non palpable
Facile à utiliser

62
Q

4 avantages d’un filler synthétique

A

Pas de transmission
pas de donneur
disponible
permanence possible

63
Q

4 inconvénient d’un filler synthétique

A

Risque de granulome
infections
migration du produit
déformations

64
Q

nommer 2 fillers biodégradable

A

graisse (??)
HA

65
Q

nommer 2 fillers semi-permanent

A

hydroxiapatithe de calcium
Acide poly-L-lactique (PLLA)

66
Q

nommer 2 fillers permanent

A

PMMA
silicone

67
Q

est-ce que l’hydroxiapatite de calcium et le PLLA forment une capsule?

A

HC: non
PLLA: oui

68
Q

3 façons de réduire la formation de nodules avec le PLLA ?

A

injectant en profondeur
reconstituer avec plus de volume (>5ml)
reconstituer overnight (>2h)

69
Q

5 éléments de prise en charge d’une occlusion artérielle

A

hyaluronisade
massage
nitropaste
aspirine
hyperbare
sildenafil, prostaglandines

70
Q

quoi faire pour prévenir injection intra-artérielle

A

Cannules
petits bolus
injecter à basse pression
retirer avant d’injecter
connaitre son anatomie
occlure à leur origine

71
Q

prise en charge d’un nodule suite à fillers

A

chaleur
massage
hyaluronidase (si HA)
excision chirurgicale
injection de cortico
Sclérothérapie

72
Q

Différence entre une injection intra-artérielle et intra-veineux?

A

Artérielle : Blancheur, froideur, immediat

Veineux : Bluish hue, légèrement delayed

73
Q

What is the pathophysiology of blindness?

A

Occlusion de l’artère ophtalmique qui occlue artère rétienne central

74
Q

quel est le endpoint de la dermabrasion

A

saignement paprika

75
Q

6 indications de microdermabrasion

A

photodamage
hyperpigmentation
rides superficielles
strech marks
cicatrice acnée
pores élargis

76
Q

quelle couche de peau la microdermabrasion affecte?

A

stratum corneum

77
Q

décrire les 3 éléments du pre conditionning pour un peel

A

Tretinoin (0.1%)(regénération du collagene, enhance the effet of the peel)
+acide glycolique (exfoliation)
+ hydroquinone (bleeching)

78
Q

3 bénéfices de faire du pre conditionning pour un peel

A

-augmente l’effet du peeling
-diminue risque d’hyperpigmentation post traitement
-diminue l’inflmmation

79
Q

décrire la composition du Jessner’s peel

A

14g resorcinol
14g acide salicylique
14cc acide lactique
100cc ethanol 95%

80
Q

nommer des indications de peel chimique

A
  • élastose solaire
  • rides superficielles
  • Dyschromie
  • Lentigo solaire
  • KA
  • Acnée rosacée
  • mélasma
81
Q

Effets des peels chimiques sur l’épiderme et le derme?

A

Épiderme :
§ augmente les mélanocytes
§ reforme les rete ridge
§ uniformise les cellules
Derme :
§ organise le collagène
§ augmente les fibroblasts
§augmente l’épaisseur du derme

82
Q

what are the Obagi stages

A

1: pink white (ad papillaire)
2: dense white (dans réticulaire superficiel)
3: grey white (en mid-réticulaire)

83
Q

2 avantages des peel profonds vs le TCA?

A

Moins d’hyperpigmentation
Moins de cicatrices hypertrophiques

84
Q

compositions du Baker-Gordon peel

A

i. Savon
ii. H2O
iii. Huile de croton
iv. Phenol

85
Q

complications des peel

A

-Hyper/hypopigmentation
-Brulures
-Erythème persistant
-Acné, milia
-Cicatrices hypertrophiques
-Infections : HSV
-Céphalées
-Systémique: artyhmie (Baker), rein (Baker), oedème laryngé (peel profond), hypothyroidie (Jessnes)

86
Q

qu’est-ce que la cohésivité d’un filler

A

Cohésivité d’un filler HA est la force les liens qui tiennent une unité d’acide hyaluronique ensemble

Questions pratiques de l'Université Montréal (41 decks)

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