Surface Medical Esthetics PLLC Kathleen Connolly Grand Canyon

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 �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 use �FDA 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, 2008 � 1. ) Botox � 2. ) Dermal Fillers � 3. ) Chemical Peels � 4. ) Laser Hair Removal � 5. ) Microdermabrasion � 6. ) Vein Treatments 5, 014, 446 2, 703, 005 1, 048, 577 891, 712 841, 733 375, 328

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

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.

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 injection �Transient headaches �Swelling �Pain �Edema at injection site �Infection �Rhinitis �Nausea �Muscle weakness �Hypertension �Flu-like symptoms �Diplopia, Double vision, and Lip Ptosis

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 CO 2 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

Soft Tissue Augmentation Dermal 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

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 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.

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

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

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

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

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 -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