Trade Name: Juvederm Voluma XC
Allergan
FDA Approved: November 2015
Injected into Submuscular /Subdermal plane
lml prefilled syringes
Vycross technology—90 % LMWHA+10%HMWHA
Hyaluronic Acid Cohesive Gel
01. Trade Name: BELOTERO Balance 02. Merz Aesthetics: 866-862-1211 03. FDA Approved: 11/16/11 04. Injected into Mid-deep dermis 05. lml prefilled syringes, $240 06. Cohesive Polydensified Matrix Technology
LESSON 1: Semipermanent Fillers
Calcium hydroxylapitite | Trade Name: Radiesse (Merz)
FDA approved 2006 for treatment of facial wrinkles and folds.
Not for lip augmentation
Longevity: 12+ months
Subdermal injection
This filler “improves” over time I 1.5ml-$562
LESSON 2: Permanent Fillers
✓ Trade Name: Silikon 1000, Vitresil
✓ Indicated for retinal detachment, not FDA approved for cosmetic use but is used off-label
✓ Longevity: Permanent
silicon oil
✓ Polymethylmethacrylate (PMMA)
✓ Trade Name: ArteFill, Bellafill
✓ Suneva Medical, Inc., 858-550-9999
✓ Suspended in bovine collagen, so must be allergy tested
✓ Contains 0.5% Lidocaine
✓ FDA approved 2006 for nasolabial folds
✓ FDA approved 1/2015 for acne
✓ Longevity: Permanent
LESSON 3: Autologous Growth Factor
✓ PRP/platelet rich fibrin matrix (PRFM)
✓ Trade names: Selphyl (UBS aesthetics) and
✓ MyCells (Kaylight Corporation), harvest PRP
✓ Patient’s blood is drawn into an anticoagulant in a specialty tube or prep pack
✓ After centrifugation, the platelets and fibrin form a matrix.
✓ PRP is injected to stimulate cell proliferation.
✓ Volume is increased and the skin is
✓ Rejuvenated by targeted tissue regeneration.
✓ Selphyl $1100/$700 per kit (Check current pricing in your area), harvest-buy centrifuge then disposables
What Is Hyaluronic Acid (HA)?
01. HA is a naturally occurring substance that, in the skin, forms the fluid matrix in which collagen fibers are embedded
02. is negatively charged and bindsenormous amounts of water, giving skin its supple, resilient quality
03. The amount of HA in the skin decreases with age, resulting in reduced dermal hydration and increased wrinkling
HA Physiochemical Attributes
✓ The half-life on natural HA in tissue is only 1-2 days. KB W
✓ HA molecule are chemically cross-linked, forming more stable macromolecules which have the same biocompatibility as native HA, but are water-insoluble.
✓ ‘Shear-thinning’ gels: Under pressure of injection, gel can pass through a relatively small gauge needle, but removal of the shearing force causes increased viscosity.
✓ Viscosity also decreases with warmer temperature.
Classification Methods
01. Source of HA
03. HA concentration
02. Method and degree of cross-linking
04. Particle size NOT
Suggested For:
01. Dynamic rhytids
02. ‘Ice pick’ and other non- distensible scars
03. Widened surgical scars
04. Actinic damage of lips
05. Extensive facial rhytids
SIDE EFFECTS
Herpetic outbreak – prophylaxis recommended.
infection good aspectic technique a must
Swelling/Bruising – common, self-limited. Ice
recommended post-op. Avoid ASA/NSAI Ds prior to injection.
Nodules (depending on product injected)
Respond to massage, or to local injection of corticosteroid and massage.
Tenderness – will resolve in 1-5 days
Pain – Recommend good topical anesthetic or dental block.
Erythema Itching
Consultation
Assess expectation_ silk purse from a sow”s ear. Attempt to determine if expectations are reasonable
Medical History_ make sure there are no contraindications to treatment
Medications- ASA”s, NSAID”s should be avoided prior to the treatment. Accutane avoid treatment Untill off for six month
Use manual strecthing of skin to demonstrate how well a particular perceived imperfection may or may not respond to filler.
Supplement begining with “g” Ginger, Ginko, Garlic, and fish oil as this can thin the blood as well
Assess patience pain tolerance
May use ice, topical anesthetic or nerve block
Be sure patient understand the results are temporary
Explain treatment and risk and determine level of understanding
Have patient sign informed consent
Pre procedure photographs recomended
