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SOFT TISSUE FILLERS AND BOTOX

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Transcript of SOFT TISSUE FILLERS AND BOTOX

SOFT TISSUE FILLERS AND BOTOX
Dr S Narayanamurthy

USES
wrinkles
contour abnormalities

ideal filler characteristics
nontoxic
biocompatible
long lasting
reversible
off the shelf
autologous
easy to use
safe
produces positive,natural,discernable change
minimal downtime
level of placement
predictable
performs well as person ages
not discernible by touch/appearance
classification of fillers
autologous
biological
synthetic
injection techniques
nerve blocks prefered
needles
30-31G - Restlane fine lines, collagen
28G - Restylane, Perlane, Juvaderm, Radiesse
26G - Scultra ArteFill
retrograde fashion
pathophysiology of wrinkles
aging
skeletal
cellular
chronic sun exposure
definition of wrinkles
fine wrinkles
changes in texture of skin that involve superficial aspect of the skin
mimetic wrinkles
extend down to middle level of dermis
furrows
full thickness of dermis
folds
larger grooves with some amount of skin overlap

FILLERS and BOTOX
skeletal changes
decrease in maxillary height
decrease in alveolar height
ligamental laxity
cellular changes
cells divide slowly
epidermis thins out
epidermal - dermal junction becomes flatter
decreased integrity of stratum corneum
basal cells atypia
chronic sun damage
thicker epidermis
decreased collagen count
heliodermatitis
solar elastosis
reduction in ground substance
autologous fillers
dermis, cartilage, SMAS, breast implant capsule
fat
fascia
platelet rich fibrin matrix(PRFM) - selphyl
cultured fibroblasts (LAVIV)
biologic fillers
acellular soft tissue matrix
collagen
Hyaluronic acid products
fascian
alloderm
acellular structurally intact sheet of human cellular graft
lip augmentation, nasolabial fold correction, glabellar wrinkle softening, rhinoplasty, septal perforation, frey's syndrome, scar treatment
preserved particulate human facial graft
prescreened human cadaver fascia lata
cymetra
lypophilised acellular collagen matrix from human cadaver skin in particulate form
lips, nasolabial folds deep wrinkles
surgisis
lyophilised collagen matrix from porcine source in sheet form
fascial replacement
other biological fillers
zyderm
zyplast
cosmoderm
cosmoplast
hyaluronic acid
gycosaminoglycan found in skin, bone, cartilage and synovial fluid
isovolemic degradation
Restylane, Perlane, Restylane touch
Elevess
Prevelle Silk
Juvederm fillers
synthetic fillers
silicone
AdatoSil 5000
Silikon 1000
Bioplastique
Polymethylmethacrylate (PMMA)
ArteFill (Artecoll)
ArteSense
Calcium hydroxyapatite
Radiesse
Poly-L-lactic acid (PLLA
Sculptra (New-Fill)
injection techniques
simple linear threading
serial linear threading
radial fanning
cross hatching
serial puncture deposition
glabellar lines
nasolabial folds
lips
tear trough
deeper creases
malar augmentation
prejowl sulcus
nasolabial fold
marionette lines, prejowl sulcus
lower cheek
uses
glabellar lines
forehead lines
eyebrows
tear troughs
nasolabial folds
malar augmentation
Marionette lines
jawline augmentation
panfacial volumetric augmentation
facial lipodystrophy
lips
nasal reshaping
scars and deformities
hand rejuvenation
botulinum toxin
1gm of BTX can kill 1 million people
botulus = sausage
treatment of strabismus and blepharospasm
Jean and Alister Carruthers

types
Clostridium botulinum
150kDa gene product
serotype A complexes
onabotulinumtoxinA - Botox
AbobotulinumtoxinA - Dysport
IncobotulinumtoxinA - Xeomin
topical BTN A - RT001
Serotype B complexes
rimabotulinumtoxinB - Myobloc


mechanism of action
reconstitution supply and storage
Botox - 100bU vials(alb 500microgm, NaCl 0.9mg)
Dysport - 300 sU vials(alb 125microgm, lactose 2.5mg)
reconstituted with 2.5ml unpreserved saline
used within 4 hrs
can be stored for 6 weeks at 4deg C
insulin syrige and 31G needle
onset and duration of action
detectable rhytid reduction - 3-7 days after injection
max benefit after 2 weeks
duration of effects 3 - 5 months
longivity depends on
dose
age
size and strength of muscle
treamentof specific areas
glabellar lines
forehead lines

lateral eyebrow lift
crow's feet
bunny lines
lips
DAO, Marionette lines and Mentalis
platysmal bands
injection dose
complications
product related
immunologic phenomenon
sarcoidosis
fixed drug erruptions
technique related
bruising
edema
pain
erythema
transient numbness
headache
seepage to adjacent areas
thank you
mr spock appearance
deer in headlight appearance
complications
lumps, bumps, irregularities
ecchymosis
overcorrection
erythema
intermittent swelling
allergic reactions
telangiectasia
granulomatous reactions
soft tissue necrosis and embolic phenomenon
herpetic outbreak
cautions
unrealistic expectations
prone to keloids and hypertrophic scar
infection, foreign body reaction and inflammation
blood thinners
telangectasias
pregnancy, breast feeding, <18 years
connective tissue disorders
Full transcript