Cosmetic Surgery Flashcards by lucky meisenheimer

What bacteria produces hyaluronic acid for fillers

Streptococcus equi species

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Name 4 hyaluronic acid fillers

Restylane
Juvederm
Perlane
Belotero

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What is the ratio of Boxtox to Dysport

1:3

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What is the brand name of Onabotulinumtoxin-A

Botox

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What is the brand name of Abobotulinumtoxin-A

Dysport

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How does botox work.

Cleaves SNAP25 in the PREsnaptic neuron preventing acetylcholine release.

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What is the brand name of Botulinum toxin B

Myoblox or Neuro/block

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What is the difference between Botulinum A an B

Botox/Dysport (A) cleaves SNAP25 in the SNARE complex while Myobloc/Neuroblock cleaves Snynaptobrevin

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What is the chemical irritant agent used in sclerotherapy

Chrom alum Glycerin FDA approved but off label

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What is an hyperosmotic agent that is used in sclerotherapy.

Hypertonic Saline 18-30% FDA approved for abortions off label for sclerotherapy.

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Name four detergents used in sclerotherapy

Sodium tetradecyl sulfate FDA approved
Polidocanol FDA approved
Sodium Mortuate FDA approved
Ethanolamine oleate FDA approved (mostly varices)

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What is Deoxycholic acid

Kybella a bile acid used to treat sub mental fat.

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How many Deoxycholic acid treatments do you need.

3 to 6 one month apart. 2mg/cm2

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What are the 3 S’s in the SNARE complex

Syntaxin
SNAP-25
Synaptobrevin

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at what concentration does TAC peel give frosting

20%

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how do assess depth of penetration of a TCA peel

Frosting

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how long must you wail to assess TCA frosting

5 minutes

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At what concentration does TCA penetrate to the papillary dermis

35% Below 30% is only epidermal penetration.

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At what concentration of TCA do you get reticular dermal penetration

50% or higher

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What causes the frosting in a TCA peel

denaturation of protien

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Name three ways to increase the TCA peel depth of penetration.

repeated application
pretreat with Jessners
abraid skin first

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what are the three levels of frosting with TCA

light reticular
confluent with erythema
solid without erythema

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What are the four elements that increase longevity
to hyaluronic acid fillers

particle size bigger longer lasting
G’ elastic modulus the higher the more long lasting
cross links higher the more long lasting
concentration

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% of haluronic acid in mg/ml is made of what

The free HA (solubilized) + insoluble … free HA is metabolized quickly

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What peel requires neutralization with either sodium bicarb or h20

Glycolic acid peels

What filler can be seen with regular x-ray

Radiesse

Fillers not seen on regular x ray can sometimes be seen on what study

CT and MRI

At what level do you inject Radiesse?

dermal subQ junction

Where is on place you should not inject Radiesse? and why.

lips, granulomas

Which lasts longer Radiesse or Voluma

Voluma 2 years Radiesse 15 mos

what chemical is gore tex and or soft form

polytetrafluoroethylene

How long does gore tex last

permanent

the poly lactic acid filler is named what

Sculptra

how long does sculptra last compared to HA fillers

twice as long

what fillers are glycoaminoglycans

hyaluronic acid fillers

what level is sculptra injected at

upper Sub Q layer

what is the interval of sculptra injections

4-6 weeks

Cosmoderm is made of what

collagen

How long does collagen (Cosmoderm) last in the skin

2-4 months

What is Belotero

Hyaluronic acid filler used for fine lines & superficial rhytids lasts 6 months

Hyaluronidase may cause allergic rxns to those allergic to what?

Bee and wasp stings, Hyaluronidase is found in venom of wasps and bees and may be responsible for allergic rxns from the stings.

what can be used prior to a peel and for how long to prevent post inflammatory hyperpigmentation

2% hydroxychloroquine for 4 weeks prior to the procedure and or retin A up to one wk prior to peel

how long should retinoic acid be stopped prior to a peel

1 week, use before this can help get a more uniform peel

what is a brody peel

35% TCA + solid CO2

what % of people develop auto antibodies to Botox making it less effective.

What drugs can enhance the effect of Botox

aminoglycosides (micin antibiotics), Ca channel blocker (Cardizem -Diltiazem/ Procardia-Nifedipine , cyclosporine, anticholinergics (atropine)

besides Glycolic acid what other peel requires neutralization

Pyruvic acid peel

How long should you wait to neutralize a Glycolic or Pyruvic acid peel. and what should you neutralize it with?

when clinical endpoint of erythema is reached at 2-4 minutes with water rinse or 10% sodium bicarbonate solution. If no erythema then neutralize no later than 5 minutes.

Jessner's solution is what formula

Resorcinol 14 gm Sal Acid 14 gm lactic acid 14 gm Ethanol added to 100ml

Modified Jessners solution replaces Resorcinol with what?

8% citric acid

how do you prep the skin prior to a Jessners peel

degrease with alcohol then acetone scrub

What is one nice side effect of Botox regardless of treatment site

Mood improves

what component of the Baker Gordon phenol peel is responsible for the depth of penetration

croton oil (is a keratolytic)

what is the freeze thaw time

the freeze time + the thaw time total time

what is the temperature of liquid nitrogen

-196 centigrade

What fillers need a skin test x 2 two wks apart

Artefill, zyplast, zyderm (all made from bovine collagen) 2% of those neg first test become allergic

What is Hylaform known as

Restylane

The hyaluronic acid in Hylaform

Rooster comb

Of the three classes of sclerosants what is the only class approved by the FDA Detergent, Osmotic Irritant

Detergent

What is the osmotic sclerosant and how does it work

23% Hypertonic Saline (half that for 1mm veins or less) it works by dehydrating and denaturing the endothelial cells

What is the irritant sclerosant?

Glycerin (Chrom alum glycerol)

what sclerosant is most likely to cause ulceration

23% Hypertonic Saline

what sclerosant is most likely to cause cardiac problems

Sodium Morrhuate

What sclerosant is most likely to cause venous thrombosis

polidocanol

how do detergent sclerosants work?

They denature edothelial cells

Name four detergent sclerosants

polidocanol Sodium tetradecyl sulfate STS Sodium Morrhuate Ethanolamine Oleate

Which sclerosant is most likely to give an allergic reaction

STS Sodium tetradecyl sulfate

When do you do HSV prophylactic treatment for chemical peels.

- Superficial peel not needed unless there is a HSV hx - Mid strength day before or day of for 7 days - Deep peel/laser resurfacing day before or day of for at least 10 days.

damage to what organ can be caused by phenol peels?

phenol

Name one absolute contraindication for Liposuction

Pt's desire to use it as a weight loss technique

What is the newest toxin for glabellar wrinkles?

Jeuveau (Prabotulinumtoxin A)

How does Prabotulinumtoxin work

It is a type A toxin and cleaves SNAP25

What is the conversion of Botox to Myobloc

1:40

What is the conversion of Botox to Xeomin and Jeuvaue

1:1

why does liposuction help with bromhidrosis and Hyperhidrosis

Some Sweat glands and Apocrine glands are located in the Sub Q fat and subsequent fibrosis in the dermis reduces the sweat.

Is excessive scarring in the treatment area an absolute contraindication for liposuction or a relative contraindication.

absolute.

Name four absolute contraindications for liposuction.

weight loss untreated psychiatric disorders dysmorphic syndrome excessive scarring in the treatment area

what is the maximum volume to be removed with tumescent liposuction

4500cc

why is it better to use punch biopsy openings for the cannula than 11 blade slits

they want the holes to remain open in the immediate post op period to reduce edema and bruising

what is the difference between pitting and non pitting edema

pitting edema is due to water, non pitting edema may be due to hypertrophic fat from lymphedema and may be amenable to liposuction treatment

Why would you not use Bupivacaine in tumescent liposuction in place of Lidocaine?

Because of it's cardiotoxic effects in larger doses.

What are four contraindications for microneedling?

History of keloids Current infection bacterial or herpes Immunosuppression Active acne in treatment area

The half life of Hyaluronic acid is about 24-48 hours how is it broken down.

Hydrolysis into CO2 and water

In Jessners solution contains what that may cause ochronosis

Resorcinol

What is this condition and what three drugs may cause it?

Ochronosis hydroquinone Resorcinol (Used in Jessners solution) Hexachlorophene (a phenol used in Baker Gordon peels)

What is the size of telangiectasias?

1mm or less

a venulectasia is what size

1 to 2 mm

a reticular vein is what size.

2 to 4 mm

Name three varicosities and their sizes.

telangiectasia 1 mm or less Venulectasias 1 to 2 mm Reticular veins 2 to 4mm

What is the treatment for erythema ab lipoaspiration

none only father time

What is the for erythema ab lipoaspiration

too superficial liposuction disrupting the subdermal vascular plexus

what is the maximum dose of Lidocane with epi in tumescent liposuction?

55mg/Kg or 8 x the normal maxium for skin surgery

what sclerosing agent has some anethetic properties?

polidocanol (think of the lido in the name)

What is artefill? aka Bellafill

dermal filler of bovine collagen mixed with polymethylmethacrylate microspheres stimulates collage formation needs a skin test 4 weeks before lasts 5+ years

What muscle may get deinervated when treating crow's feet with botox which causes a unilateral drooping mouth.

zygomaticus major

What is the frankfort line when injecting Botox

an imaginary line from the tragus to the infraorbital rim which it is considered safe to inject above.

What muscle creates bunny lines

Nasalis

When might the risorius muscle which affects the corners of the mouth might be accidently injected if you are injecting what muscle.

Masseter Muscle Make sure you inject the Masseter (for hypertrophy or clenching teeth) in the posterior 2/3 rds as you might affect the risorius in the anterior 1/3

What is Rimabotulinumtoxin brand name

Myobloc/NeuroBloc

If a person does not have a history of HSV do you need prophylaxis for a mid strength peel?

Yes day before or of extending for 7 days.

Cosmetic Surgery Flashcards

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