Injectable soft tissue augmentation

Question 1

What two areas are particularly dangerous/susceptible to vascular adverse effects from filler?

Answer 1

The glabella and perinasal

Question 2

How long prior to filler injection should vitamin E and non-essential platelet inhibitors be held?

Answer 2

10-14 days

Question 3

Which fillers cause “blue nodules” in the skin and why are they blue?

Answer 3

HA-fillers and they are blue due to the Tyndall effect

Question 4

How can nodules/granulomas from fillers be treated?

Answer 4

Intralesional steroids or hyaluronidase for HA fillers

Question 5

What treatment should be done for painful blanching or necrosis from occlusion from a filler?

Answer 5

Hot/warm compress, tapping the area, topical nitroglycerin, injection of hyaluronidase (if HA filler)

Question 6

Occlusion of which vessels by filler can cause blindness?

Answer 6

Suprotrochlear or supraorbital arteries –> can lead to occlusion of the central retinal artery

Question 7

Which fillers had the highest risk of anaphylaxis?

Answer 7

Bovine collagen (Zyderm/Zyplast). These are now off the market

Needed two negative skin tests prior to treatment

Question 8

What is polymethacrylate (ArteFill) and how long does it last?

Answer 8

Permanent filler for deep wrinkles made from polymethacrylate suspended in bovine collagen

Question 9

What must be done prior to using polymethacrylate filler?

Answer 9

Skin testing 30 days prior to procedure

Question 10

Where is the injection of polymethacrylate targeted for?

Answer 10

Deep dermis

Question 11

What are the uses of calcium hydroxyapatite (Radiesse) filler?

Answer 11

Deep wrinkles, HIV lipoatrophy, hand rejuvenation

Question 12

How long does calcium hydroxyapatite (Radiesse) filler last?

Answer 12

9-18 months

Question 13

Which filler can be seen on X-ray?

Answer 13

Calcium hydroxyapatite (Radiesse) filler is radio opaque

Question 14

What is the primary use of Poly-L-lactic acid (Sculptra)?

Answer 14

HIV lipoatrophy and deep wrinkles

Question 15

How long does Poly-L-lactic acid (Sculptra) last?

Answer 15

9-18 months

Question 16

What is the “rule of 5’s” for Poly-L-lactic acid (Sculptra)?

Answer 16

For massaging in the product –> 5 minutes at a time, 5 times a day, for 5 days

Question 17

If nodules/papules are seen after injection of Poly-L-lactic acid (Sculptra) what happened?

Answer 17

Didn’t inject deep enough, needs to be a deep injection

Question 18

What component of a hyaluronic acid (HA) fillers contribute to the strength of the filler?

Answer 18

Only cross-linked hyaluronic acid, free HA does not contribute

Question 19

What is the importance of crosslinking of HA for HA fillers?

Answer 19

Natural HA is degraded rapidly, crosslinking makes it more resistant to breakdown, thus the higher the % of crosslinking, the longer it lasts

Question 20

What is the G’ of a filler?

Answer 20

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)

Question 21

What is the effect of a HA filler with a higher G’?

Answer 21

More volume support after injection

Question 22

What is the viscosity of a filler?

Answer 22

This is the resistance to flow, the higher the viscosity the harder to push through the syringe

Question 23

What anatomic area should not be injected with calcium hydroxyapatite (Radiesse)?

Answer 23

The lips

Question 24

Which fillers are painful and often needs to be mixed with lidocaine?

Answer 24

Calcium hydroxyapatite (Radiesse), restyle/Restylane-L, Perlane/Perlane-L, Juvederm,

Question 25

What is an indication for autologous fat transfer for cosmetic purposes?

Answer 25

Large volume that needs to be filled

Question 26

What is an important disadvantage of autologous fat transfer?

Answer 26

Less predictable effects, unclear how much of the fat will take and mature

Question 27

How long do most HA fillers last?

Answer 27

6-12 months

Question 28

Which filler is made from rooster comb?

Answer 28

Hylaform (HA filler) [Only lasts 3-4 months]

Question 29

Which HA filler has the highest G’?

Answer 29

Perlane

Question 30

Which HA filler has the lowest G’?

Answer 30

Juvaderm Ultra