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facial injectables > Botox tx areas + dosage + administration > Flashcards

Botox tx areas + dosage + administration Flashcards

(77 cards)

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1
Q

off label?

A

means more to the manufacturerer of a drug

ex - allergen manufacturer of botox
- they have submitted for permission to sell botox - can only supply for applications they applied for

so only advertise for those on label applications

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2
Q

off label comes into play when

A

if data supports use of a product in an area - as a clinician you are in rights to use it for that

  • it has to be firmly embedded in science

(people out there that are selling things that arent under knowledge)

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3
Q

off label with scientific bedding?

A

can use for the purposes

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4
Q

factors that influence beauty

A

7 main ones

  1. facial shape - chin, cheeks, symmetry (phi)
  2. forhead height
  3. eyebrow shape
  4. eye size - inner eye distance
  5. nose shape
  6. lips - lenght and heght
  7. skin clarity texture and color
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5
Q

new patient assessment

start by?

A 
start by looking at 
skin quaity
skin laity 
facial fat assessment - full or empty 
muscles - hyperdynamic or iniimate
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6
Q

facial assessment

all angles to look at

A

dynamic vs static rhytids

brow position and contour

muscle hyperactivity

eyelid ptosis

facial weakness - asymmetry

contour defects

lines, creases

patient preferences

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7
Q

dynamic rhytids

A

raise eyebrows and see the lines

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8
Q

static rhytids

A

lines in face - that stay on rest

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9
Q

top 2 procedures

A

botox (7.4 million)

and soft tissue fillers (2.6 million)

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10
Q

avoid when possible - 10 days prior to procedures

A

NOT a deal breaker but could have additional bruising

NSAIDs
ASPIRIN
FISH OIL
OMEGA 3'S 
FLAX SEED OIL
VITAMIN E 
GINGKO BILOBA
LICORICE
COQ10
CAYENNE 
GINGER
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11
Q

post op instructions why???

A

bonta binds to site within 1.5 hours of injection

no facials that day

avoid sun exposure

do not manipulate area for 2 hours

no exercise for 2 hours

make up application per practioners discretion

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12
Q

safety profile

A

used in clinical

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13
Q

safety profile

A

used in clinical since 1970’s

no known lethal dose

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14
Q

human lethal dose?

A

unknown – doses required to cause systemic side effects are difficult to predict

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15
Q

when botox used for dystonias and a lot / higher doses

A

may see some side effects potentiallt

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16
Q

the botox appointment consists of

A

discussion and diagnoisis

pre-treatment phtogrpahs

informed consent

mark injection sites

decide on dosing

prepare botox for injection then inject

post tx instructions

re appoint for follow up (suggests 2 weeks)

expect appointments to last 15-20 minutes

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17
Q

forhead rhytids

A

only the horizotnal bands
- bands go completely across all the way up

galia - all the way up

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18
Q

forhead rhytids treat with?

A

frontalis injection
only the horizotnal bands
- bands go completely across all the way up

galia - all the way up

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19
Q

frontalis muscle

dosing?

A

only elevator of the forehead
inserts in eyebrow skin

elevates brow strongly

elevates eye weakly

botox = 4-25 U
moderatley deep

no standard injection pattern and not common to be bifid - usually uninterupted accros frontal bone

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20
Q

adverse events with frontalis

A

overly smooth artifical appearance

brow ptosis and eyelid ptosis in patients using frontalis as accessory eyelid elevator

only thing that picks it up is frontalis

if tell frontalis to stop lifting

brow complex will fall down more if give too much

treat the glabellar complex as well if treat the frontalis
- can get more ptosis

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21
Q

adverse events of frontalis

A

excessive denervation will cause an OVERLY SMOOTH ARTIFICIAL APPEARANCE

as well as BROW PTOSIS

and eyelid PTOSIS

in patients usin frontalis as an accessory eyelid elevator!

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22
Q

*if botox in fontalis is not distributed laterally

A

peaking of the eyebrows will occur

if it is not distributed laterally enough

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23
Q

peaked brow in men

A

prob didnt get lateral enough with frontalis injection

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24
Q

deep vs hooded eyes

A

can you see palbreal crease?

- more likely deep set eyes

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25
over due frontalis? advantage in
as tissue descends - has a place to go advantage in deep set eyes
26
glabellar complex muscles + function
corrugator supercilii (bilateral) midline procerus bilateral depressor supercilli MAJOR BROW DEPRESSOR
27
corrugator muslcles
corrugator supercilli wrinkles forhead vertically see 1's or 11's with contraction
28
procerus muscle
aides in pulling skin between eyebrows downwards HORIZONTAL BANDS / WRINKLES ACROSS BRIDGE OF NOSE *part of globellar complex
29
horizontal frowner?
vertical muscles - lines perpinduclar to their name!!
30
vertical may need more botox where
procerus muslce
31
placement of glabellar complex ON INJECTION
iNjection must be 1 cm away from oribital rim BOTOX 20-30 UNITS dont use eyebrows as a guide
32
rare adverse events in glabella
all side effects disappear completely with time diplopia, droopy eyelid, tearful eye eyelid ptosis - getting into levator palpebrae muscle - if get it behind the eye
33
treatment for eyelid ptosis
iopidine .5% apraclonidine two gtt's 3-4 times / day for 2-3 weeks effect seen 30 minutes after administrtion - lasts about 2-3 hours
34
diplopia adverse affect of?
rare side effect - spread into muscles of occular movement into the SUPERIOR RECTUS - is the weakened muscle can have blurred vision b tox into upper lid through superior rectus is the weakend muscle * avoid going too medial!
35
wht to do to avoid adverse outcomes 4 things listed
adjust sites and dosages to aoid lip ptosisi -- injection should be distanced from middle segment of upper lid injection of medial (near nose) lower lid site to be avoided to avoid diplopia or tearful eye may also require delting injections more than usual, instead of just decreasing dose
36
crows feet fix?
injection with obicularis oculi which closes the eyelids dealing with orbicularis oculi action - closes eyelid
37
orbicularis oculi - general + injection site
closes eyelids can pull down lateral brow as well placement pattern varies from 1-3 sites on average - with 3-12 on each side
38
adverse events in orbicularis oculi
lip ptosis - toxin injected below the zygoma and into the zygomaticus major
39
inferior oblique muscle
double vision if too medial on orbicularis oculi becuse inferior oblique
40
'brow lift' deals with
superolateral orbcularis oculi masseter and temporalis
41
superolateral orbcularis oculi | + finding location
browlift divide eye into quarters top lateral area is the target ask patient to squeeze their eyes closed - reveals the superolateral extent of the orbicularis oculi which pulls down brow 1-2 units per side
42
adverse effects of brow lift with superolateral orbicularis oculi
most common is bruising ptosis can occur (levator palpebrae muscle)
43
when to use neurotoxins in masseter and temporalis?
recurrent abfractions veneer delaminations repeat fracture also masseter -- used cosmetically for slenderizing the lateral face
44
botox never be used for ?? *
NOT BE USED AS A FRONTLINE TREATMENT FOR TJ DYSFUNCTION
45
MYOFACIAL PAIN AND TRIGGER POINTS??? use botox?
INSUFFICIENT EVIDENCE to support the use of botulinum toxin for MPS or trigger points get same result when use silane or lidocaine NOT indicated for this then -- except for the MOST REFRACTORY of cases
46
temporalis muscle
used to help in brow lift inserts into coroinioid elevates and retractes mandible dosing is 5-15 per side and is a DEEP injection
47
temple layers
``` I-skin II- subcutanoues tissue III- superficial temporal fascia Fat pad V- deep temporal fascia VI- temporal muscle ``` have to get through all of them
48
masseter
elevation and protraction of mandible insertion into coronoid process, ramus of mandble
49
where to inject in the masseteric nerve? side effects?
richest arborization of perforating masseteric nerve branches are confined to area V -- lower middle thirdd of masseter soreness at the injection site and asymmetry may occur 10-80 each side
50
thickness in reaching the masseter
thick! | so may need a thicker needle
51
parotid relatonship to masseter
need to be low and anteriro to the paratid
52
doses of masseter relates to
same as use of botox for silaoliathisis 1-75units - allergen type
53
bruxism
common condition - 8-31% of population 2 types = sleep and awake botox use is: safe effective better clinical results than traditional methods
54
risorius muscle
horizontal bands east to west platsyma could be present - horizontal band covering it
55
nasalis rhytides could occur adversely with? adverse events if go into nasolabial fold? placement too lateral?
opens and closes nostrils particularly on forced inspiration placement - lateral aspect of bridge of nose rhytides could occur adversely become more pronounced after glabellar and orbicularis oculi tx with bonta adverse - lip ptosis (if go into nasolabial fold) + double vision if placement too lateral
56
types of smiles?
1, mona lisa smile - raises commissures to highest point of smile dominant muscle is the zygomaticus major (most common) (67%) 2. canine smile - dominant muscle is the levator labii superioris - mid upper lip raised higher than oral commissures (31 %) 3. full denture smile - simultaneous firing of elevators and depressors (2%)
57
excessive gingival display
indicated use botox
58
philtrum heigh / labial height?? anything less than 3??
philtrum height divided by labial height =3 oe less = WNL normal too big - make look masculin
59
levator labii superiorus alaque nasi injection site too superficial of llsan over dosing?
dilates nostril and raises upper lip can help with excessive gingival display lateral to the nose tip - wide dosing range and 1-5 per side - need to adjust for any present assymmitries that already present too superficial =no effect over dosing = too little tooth show
60
adverse events of llsan
asymmetry
61
depressor septi nasi
may be absent or underdevloped in some individuals above central / laterals and canines pulls nasal tip down with smiling
62
depressor septi nasi
may be absent or underdevloped in some individuals above central / laterals and canines pulls nasal tip down with smiling
63
tpye 1 of depressor septi variations
most common | - visible identifiable can be traced to full interdigitation with obicularis oris from origin at medial cural footplate
64
depressor septi nasi wont improve
someone with severly ptotic nose with thick sebaceous skin
65
adverse effects of depressor septi nasi
a flat upper lip, a droopy upper lip
66
mentalis general
wrinkles chin and protrudes lower lip
67
bonta in chin?
improves chin esthetics by altering position of potonion in patients with an under prjection and a high ridinighyperactive mentalis muscle
68
depressor anguli oris involved in
angle of mouth down
69
adverse events on mentalis too lateral? too much?
too lateral = affect lower lip height symmetry too much in deep muscle = affect oral competency
70
4 dots on top 3 on bottom with
orbicularis oris | always 7
71
find depressor anguli oris?
ask patient to show lwoer teeth with dentition in occlusoin
72
adverse effects of DAO | toxin likely went where
aysemmtric smile with inadvertent placement of toxin in depressor labii
73
radial lip lines from which muscle? function of this muscle
orbicularis oris compress lips against anterior teeth - closes and protrudes lips
74
insertion of orbicularis oris? adverse?
4 dots on top 3 on bottom with needle inserted parallel to vermillion border - a few mm above it and below it can use a more dilute solution -orbicularis oris always 7 overdosing? -- difficulty forming the sounds p and b (bilabial sounds) + drooling
75
excessive lacrimation can occur when?
adverse effect in orbicularis orid muscel if injection too INFERIOR - due to dysfunction of evacuation of normal tear production by tear duct, situated on edge of lower lid in corner near nose CHECK FOR SNAP TEST
76
excessive lacrimation can occur when?
adverse effect in orbicularis orid muscel if injection too INFERIOR - due to dysfunction of evacuation of normal tear production by tear duct, situated on edge of lower lid in corner near nose CHECK FOR SNAP TEST
77
treat downward oral commissures with injection into
depressor anguli oris

facial injectables (10 decks)

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