Injectable Dermal and Subcutaneous Fillers

shevyatiwari's version from 2015-04-27 01:09

Section 1

Question Answer
Bovine filler lasts 12 monthsF, 3 months
Bovine fillers are very safe and do not cause allergyF, potential of allergy - need two tests prior to treatment
Patients can be treated with 2 weeks of the second allergy test to bovine collagenT
Porcine collagen is similar to bovine collagen more so than humanF, similar to human
Allergy testing is required prior to porcine collagenF
Porcine collagen lasts 3 monthsF, 12

Section 2

Question Answer
Hyaluronic Acid
Synthetic polysaccharideF, naturally occurring
High risk of allergenicityF, low risk
Good for NLFT
C/I include allergy or hypersensitivity to componentsT
Last 6-9 monhtsT
Last longer in areas of limited mobilityT
Can be removed by haluronidaseT, works over 24 hours
When mixed with lignocaine, causes 50% less painT
Promotes collagen productionT
ProcoagulantF, anticoagulant,similar to heparin
Less swelling and bruising than collagenF, more - due to anticoagulant effects
Adverse effects of bruising and swelling last up to 1 weekT
Tyndall effect refers to blue discolouration of superficial fillersT
Nicking the skin, massage, hyaluronidase can be used for superficial fillersT

Section 3

Question Answer
Calcium Hydroxyapatite
A volumiserF, volumising and stimulatory
SyntheticF, naturally occurring, major component of bone
Low allergy riskT
Lasts 12 monthsF, 12-18 months, longer than HA
Stimulatory effectT, causes fibroplasia and neocollagenesis
FB reactions can impair resultsF - causes accumulation of fibroblasts which surround and protect CaHA -> slower degradation
Similar to HA, can be altered after injectionF, needs immediate moulding
Lignocaine has the benefit of making easier injecting T, also anaesthetic effect

Section 4

Question Answer
Poly L lactic acid
For shallow fillersF, for deep filling and temporal wasting
As it is resorbed, it stimulates collagen production T
Produces long lasting effects up to 3 yearsT
Fast onset of actionF, takes up to a few months
Long reconstitution times can cause palpable subcutaneous nodulesF, short reconstitution times (2 hours or less)
Shake wellT

Section 5

Question Answer
In combination with lignocaine and bovine collagenT
Requires allergy testingT, due to bovine collagen
Not good for sebaceous skinF
Good for rhytides and folds with little excess skinT

Section 6

Question Answer
Administered with a micro droplet techniqueT
FDA approved for cosmeticsF
Usually only require the one injectionF, need regular treatments
Easy to administer- can be done by anyoneF, needs specialists

Section 7

Question Answer
Adverse Effects
Most common are due to the injection processT
Injection to the artery can -> necrosis and immediate skin blanchingT
Necrosis due to injection into the artery can be managed with warm compress and topical nitroglycerin as well as hyaluronidaseT
Inflammatory nodules are often due to suboptimal location of fillerF - often infection, may require POAB's, and workup. Consider I & D
Infected fillers should be treated with dual therapyT
Hypersensitivity is very commonF
Granulomas often take over 12 months to formF, only 6 months
IL steroids can be considered if granulomas are presentT
Particulate fillers include HA, PLLA, PMMA can cause nodules which can be injected with salineT
Biofilms take 6 months to developF, 12
Biofilms require chronic suppressive doses of antibiotics and removal of the biofilmT