Kathleen Connolly Grand Canyon University October 9, 2013.

Surface Medical Esthetics, PLLC

Kathleen ConnollyGrand 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

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

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 useFDA Approved on April 15, 2002 for

moderate-severe horizontal forehead lines, glabellar, and eye areas (crow’s feet).

Top Six Most Popular Cosmetic Non-surgical Procedures, 20081.) Botox 5,014,4462.) Dermal Fillers 2,703,0053.) Chemical Peels 1,048,5774.) Laser Hair Removal 891,7125.) Microdermabrasion 841,7336.) Vein Treatments 375,328

Botulinum Type AA Highly refined purified proteinAbsolutely no live bacteriaThe injection can not give you an infection

(such as botulism)The toxin blocks the nerve impulse that

controls muscle movementRestricts the patient’s ability to contract the

facial musclesNo contraction= no movement= no wrinkles!Results typically last 3-6 months

Mechanism Of ActionCreates a paralyzing effectBotulinum Toxin A actually effects the nerves,

not the musclesBotulinum Toxin A prevents the release of

acetylcholineThe muscle itself is not alteredDoes not alter sensory nervesTherefore, it does not make the skin numbOnce the product wears off, wrinkles return, but

are not any worse than before the treatment.

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)

Some Possible Side Effects:

Ecchymosis: associated with any type of injectionTransient headachesSwellingPainEdema at injection siteInfectionRhinitisNauseaMuscle weaknessHypertensionFlu-like symptoms Diplopia, Double vision, and Lip Ptosis

ContraindicationsDermatitis or infection at site to be treatedMarked Facial Asymmetry (i.e. Bells Palsy)Deep Dermal ScarringSevere Anxiety related to needle painCurrently using antibiotics and /or aminoglycosidesNatural eyelid Ptosis (present with a non-arched eyebrow)Patients who have undergone facial surgery, recent

blepharoplasty or CO2 laser resurfacingPregnant and /or Lactating womenHypersensitivity to any ingredient in Albumin (human blood

product)Neurologic Disorders ( Myasthenia Gravis, Parkinson’s Disease,

Multiple Sclerosis) Fever, Flu, or Cold symptoms

Soft Tissue AugmentationDermal FillersFillers can be classified into two main

categories:1.) Permanent2.) Non-permanent

Other classifications include:1.) Biodegradable or non-biogradegradable2.) Animal or non-animal3.) autologous or non-autologous

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)

Common Temporary Filler ProductsJuvederm 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.

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 rays

ContraindicationsIn patients with severe allergies and a history

of anaphylaxisPatients who are allergic to gram positive

bacterial proteinsShould not be injected into a blood vesselPatients with known susceptibility to keloid

formation or hypertrophic scarringPregnant or Lactating women

Possible Side Effects Hyaluronic Acid based products (Juvedrem,

Resrylane, Perlane) can cause:ErythemaSwellingMild pain /discomfortItchingDiscolorationTendernessPruritisNodules

The ConsultationIndividual Facial analysisListen to what the patient is unhappy about (with

their appearance)Obtain a medical historyTiming of treatmentAssess the patient’s need for pain managementCommunicate that tough-ups made be neededCost of treatmentRealistic results of the treatmentBefore and after photos Obtain an Informed Consent

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)

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

Any Questions?????

References Dover, J.S. (2005). Clinical use of Restylane. Skin Therapy Letter. 10 (1): 5-

7Retrieved 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