Kathleen Connolly Grand Canyon University October 9 2013 The Art amp Science Of Botulinum Toxin A amp Dermal Filler Implantation Baby Boomers people born between 19461964 are reaching middle age ID: 685520
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Slide1
Surface Medical Esthetics, PLLC
Kathleen Connolly
Grand Canyon University
October 9
,
2013Slide2
The Art & Science Of Botulinum Toxin A & Dermal Filler Implantation
Baby Boomers (people born between 1946-1964) are reaching middle age
Unlike other populations, they refuse to let the aging process define them
Physical appearance is very important to many people in this population
People are now more open about cosmetic procedures
The stigma associated with cosmetic procedures has decreased greatly
People want to look and feel more youthfulSlide3
Treatment Options
There are 7 serologically different neurotoxins produced by Clostridium
Botulinum
bacteria (A, B, C, D, E, F & G).
Botulinum
Toxin Type A = Most potent.
Only
Botulinum
A & B are available for clinical use
FDA Approved on April 15, 2002 for moderate-severe horizontal forehead lines,
glabellar
, and eye areas (crow’s feet).Slide4
Top Six Most Popular Cosmetic Non-surgical Procedures, 2008
1.) Botox 5,014,446
2.) Dermal Fillers 2,703,005
3.) Chemical Peels 1,048,577
4.) Laser Hair Removal 891,712
5.) Microdermabrasion 841,733
6.) Vein Treatments 375,328Slide5
Botulinum Type A
A Highly refined purified protein
Absolutely no live bacteria
The injection can not give you an infection (such as botulism)
The toxin blocks the nerve impulse that controls muscle movement
Restricts the patient’s ability to contract the facial muscles
No contraction= no movement= no wrinkles!
Results typically last 3-6 monthsSlide6
Mechanism Of ActionCreates a paralyzing effect
Botulinum
Toxin A actually effects the nerves, not the muscles
Botulinum
Toxin A prevents the release of acetylcholine
The muscle itself is not altered
Does not alter sensory nerves
Therefore, it does not make the skin numb
Once the product wears off, wrinkles return, but are not any worse than before the treatment.Slide7
Common Areas Treated Used in the treatment of facial lines that result form a pull for the muscles from expression
Known as dynamic wrinkles (wrinkles in motion)
Successful in treating the upper third portion of the face
Primary areas:
Glabellar
(frown lines between the eyebrows), horizontal forehead lines, and the Lateral
Canthal
areas (crow’s feet /outer eye areas ).
Also used for treatment of migraine or tension headaches (relaxes muscle tension)Slide8
Some Possible Side Effects:
Ecchymosis: associated with any type of injection
Transient headaches
Swelling
Pain
Edema at injection site
Infection
Rhinitis
Nausea
Muscle weakness
Hypertension
Flu-like symptoms
Diplopia, Double vision, and Lip PtosisSlide9
ContraindicationsDermatitis or infection at site to be treated
Marked Facial Asymmetry (i.e. Bells Palsy)
Deep Dermal Scarring
Severe Anxiety related to needle pain
Currently using antibiotics and /or aminoglycosides
Natural eyelid Ptosis (present with a non-arched eyebrow)
Patients who have undergone facial surgery, recent blepharoplasty or CO2 laser resurfacing
Pregnant and /or Lactating women
Hypersensitivity to any ingredient in Albumin (human blood product)
Neurologic Disorders ( Myasthenia Gravis, Parkinson’s Disease, Multiple Sclerosis)
Fever, Flu, or Cold symptomsSlide10
Soft Tissue AugmentationDermal Fillers
Fillers can be classified into two main categories:
1.) Permanent
2.) Non-permanent
Other classifications include:
1.) Biodegradable or non-
biogradegradable
2.) Animal or non-animal
3.) autologous or non-autologous Slide11
Permanent Filler Products
Artefill
(
Artecoll
): Approved in 2007, and contains Bovine Collagen
Silicone (
Silikon
1000) FDA approved for Ophthalmology
Biopolymers , Silica based (not available in the US)Slide12
Common Temporary Filler Products
Juvederm
Ultra: FDA approved in
2007
Restylane
: Approved by the FDA: December, 2003
Perlane
: Approved by the FDA: May, 2007
These are all hyaluronic acids: they are degradable and dissipate over time. They are non-animal based, no skin testing required.Slide13
PrecautionsCaution should be used with:
Patients on immunosuppressive therapy
Patients on
Nsaids
and /or Aspirin
Hypersensitive patients
Patients who have recently had overexposure to UV raysSlide14
ContraindicationsIn patients with severe allergies and a history of anaphylaxis
Patients who are allergic to gram positive bacterial proteins
Should not be injected into a blood vessel
Patients with known susceptibility to keloid formation or hypertrophic scarring
Pregnant or Lactating womenSlide15
Possible Side Effects Hyaluronic Acid based products (
Juvedrem
,
Resrylane
,
Perlane
) can cause:
Erythema
Swelling
Mild pain /discomfort
Itching
Discoloration
Tenderness
Pruritis
NodulesSlide16
The ConsultationIndividual Facial analysis
Listen to what the patient is unhappy about (with their appearance)
Obtain a medical history
Timing of treatment
Assess the patient’s need for pain management
Communicate that tough-ups made be needed
Cost of treatment
Realistic results of the treatment
Before and after photos
Obtain an Informed ConsentSlide17
What Can Fillers Do?1.) Fill in lines (smile lines,
nasolabial
folds, perioral lines, marionette lines.
2.) Fill in scars
3.) Restore the contours of the lips
4.) Add fullness to the face (cheeks, cheekbones, lips. Chin, above the eyebrows, under the eyes)Slide18
Talk to your health care professional about……The various options
Determine what facial areas you may want to enhance
Your health history
Risks and benefits of various treatment options
Prior treatments and proceduresSlide19
Any Questions?????Slide20
ReferencesDover, J.S. (2005). Clinical use of
Restylane
. Skin Therapy Letter. 10 (1): 5-7
Retrieved from: http//www.medscape.com/viewarticle/500823
Parker, S. (2008). The Art and Science of Dermal Filler Implantation. Esthetic Skin Institute. Ft. Lauderdale, FL
Parker, S. (2008). The Art and Science of
Botulinum
Toxin A. Esthetic Skin Institute.
Ft. Lauderdale, FL.
Vartanian
, J., Frankel, A., & Rubin, M. (2008). Injected
Hyaluronidase
Reduces
Restylane
-Mediated Cutaneous
Augmentation. ARCH Facial Plastic Surgery
Vol
7, pgs. 231-237