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Surface Medical Esthetics, PLLC

Surface Medical Esthetics, PLLC. Kathleen Connolly Grand Canyon University October 9 , 2013. The Art & Science Of Botulinum Toxin A & Dermal Filler Implantation. Baby Boomers (people born between 1946-1964) are reaching middle age

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Surface Medical Esthetics, PLLC

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  1. Surface Medical Esthetics, PLLC Kathleen Connolly Grand Canyon University October 9, 2013

  2. 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 youthful

  3. 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).

  4. 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 375,328

  5. 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 months

  6. Mechanism Of Action • Creates 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.

  7. 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)

  8. 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 Ptosis

  9. Contraindications • Dermatitis 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 symptoms

  10. 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

  11. 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)

  12. Common Temporary Filler Products • JuvedermUltra: 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.

  13. Precautions • Caution should be used with: • Patients on immunosuppressive therapy • Patients on Nsaids and /or Aspirin • Hypersensitive patients • Patients who have recently had overexposure to UV rays

  14. Contraindications • In 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 women

  15. Possible Side Effects • Hyaluronic Acid based products (Juvedrem, Resrylane, Perlane) can cause: • Erythema • Swelling • Mild pain /discomfort • Itching • Discoloration • Tenderness • Pruritis • Nodules

  16. The Consultation • Individual 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 Consent

  17. 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)

  18. 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 procedures

  19. Any Questions?????

  20. References • Dover, 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

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