CHAPTER 59 ■ Management of Filler Injection Complications 185
c
d
Fig. 59.1a–f (Continued) (c) Vascular injury from nonsurgical rhinoplasty in a postoperative pa-
tient. (d) Delayed hypersensitivity seen 6 months after HA injection. (continued on next page)
186 SECTION IV ■ Filler Injection Techniques
e
f
Fig. 59.1a–f (Continued) (e) Herpetic outbreak after filler injections to nasolabial folds. (f) Tyndall
effect seen on the lower eyelids.
CHAPTER 59 ■ Management of Filler Injection Complications 187
■ ■Additional Reading Niamtu J III. Complications in fillers and
Botox. Oral Maxillofac Surg Clin North Am
Cox SE, Adigun CG. Complications of inject- 2009;21:13–21, v PubMed
able fillers and neurotoxins. Dermatol Rzany B, Becker-Wegerich P, Bachmann F,
Ther 2011;24:524–536 PubMed Erdmann R, Wollina U. Hyaluronidase in
Dayan SH, Arkins JP, Brindise R. Soft tissue the correction of hyaluronic acid-based
fillers and biofilms. Facial Plast Surg 2011; fillers: a review and a recommendation
27:23–28 PubMed for use. J Cosmet Dermatol 2009;8:317–
Dayan SH, Arkins JP, Mathison CC. Manage- 323 PubMed
ment of impending necrosis associated
with soft tissue filler injections. J Drugs
Dermatol 2011;10:1007–1012 PubMed
Appendices
A
Neurotoxin/Filler Injection
Techniques Arranged by Order
of Difficulty and Level of
Experience Required
190
APPENDIX A ■ Injection Techniques Arranged by Order of Difficulty 191
Level BoNTA Fillers
Beginner Glabella Nasolabial folds
Crow’s feet Lips
Nasal tip lift Marionette lines
Dimpled chin Earlobe rejuvenation
Bunny lines Mental crease
Intermediate Forehead Oral commissure
Oral commissure/DAO Prejowl sulcus
Lateral browlift Forehead wrinkles
Chemical browlift Chin augmentation
Lip lift Temporal fossa
Smoker’s lines Acne scars
Necklace lines Lateral malar prominence
Hypertrophic orbicularis oculi Submandibular and buccal hollow
Hyperhidrosis axilla
Advanced Nefertiti neck lift Vertical lip lines
Platysmal banding Refractory glabellar lines
Nasal flare Medial midface
Gummy smile Lateral browlift
Masseter hypertrophy Dorsum of hands
Hyperhidrosis hands Liquid facelift
Hyperhidrosis feet Sculptra
Migraine
Expert Frey syndrome Tear trough
Submandibular gland hypertrophy Rhinoplasty
Parotid gland hypertrophy Nasal valve stenting
Medial orbital hollow
PMMA
B
Sample Informed Consent Form for
Neurotoxin Injections
I authorize Dr. ___________ to perform injection of Botox/Dysport/Xeomin on me.
Indications for procedure: Facial wrinkles
Risks of procedure: Bleeding, bruising, pain, infections, asymmetry, not fully im-
proved wrinkles, temporary drooping of the eyelid, need for additional treatment,
may also need filler for improved correction. In addition, there have been reports of
distant spread of botulinum toxin that has resulted in secondary problematic weak-
ness. These observations have been reported only in children being treated for spas-
ticity and have never been reported with the cosmetic use of these products.
Alternative treatments: No treatment, filler injection, chemical peels, laser re-
surfacing, etc.
Photographs: I give my consent for photographs to be taken before and after the
procedure for documentation.
I will allow these photographs to be shown to other patients. My name and other
personal information will not be disclosed. YES NO
I will allow these photographs to be placed on the Internet. My name and other
personal information will not be disclosed. YES NO
I understand that the results of these injections are not immediate and it may
take 7 to 10 days for the full effect of the injection to be seen.
I am aware that the practice of medicine and surgery is not an exact science, and
I acknowledge that no guarantees have been given to me concerning the results of
this procedure.
Patient __________________________________________ Date ___________________
Physician _________________________________________________________________
Witness __________________________________________________________________
192
C
Sample Informed Consent Form for
Filler Injections
I authorize Dr. _____________ to perform injection of _________________________
on me.
Indications for procedure: Facial wrinkles, facial aging
Risks of procedure: Bleeding, bruising, pain, infection or inflammation, asym-
metry, not fully improved wrinkles, lumps, nodules, vascular injury or occlusion,
scarring, need for additional treatments, delayed hypersensitivity, allergic reaction.
(Additional risk for PMMA: This is a permanent product and cannot be removed.)
Alternative treatments: No treatment, use of a different filler product
Photographs: I give my consent for photographs to be taken before and after the
procedure for documentation.
I will allow these photographs to be shown to other patients. My name and other
personal information will not be disclosed. YES NO
I will allow these photographs to be placed on the Internet. My name and other
personal information will not be disclosed. YES NO
Anesthesia: I consent to the administration of anesthetics considered necessary
or advisable. I understand that all forms of anesthesia involve risk and the possibil-
ity of complications, injury, and allergic reaction.
I am aware that the practice of medicine and surgery is not an exact science, and
I acknowledge that no guarantees have been given to me concerning the results of
this procedure.
Patient __________________________________________ Date ___________________
Physician _________________________________________________________________
Witness __________________________________________________________________
193
Index
Note: Page references followed by a f or t indicate figures or tables, respectively.
A B
AbobotulinumtoxinA (BoNTA-ABO). See Dysport Belotero, 93, 129
Acetylcholine, 74, 76, 80, 82 Benzocaine, lidocaine, and tetracaine (BLT), 97
Acne scars, filler injection treatment for, 170–172, Biofilms, 183
172f Bite disorders, post-botulinum toxin injection, 67
Acyclovir creams, 182 Blanching, vascular compromise-related, 183, 184f
α-Adrenergic agonists, as eyelid ptosis treatment, Blepharoplasty patients, mild fat herniation in,
88–89 128
Aging, facial BLT (benzocaine, lidocaine, and tetracaine), 97
as midface hollowing cause, 149 BoNTA-INC. See IncobotulinumtoxinA
as oral commissure angle changes cause, 118 BoNTB. See Myobloc
as parotid gland hypertrophy cause, 69 Botox
as submandibular gland ptosis or hypertrophy for lip lift, 45–46, 46f
cause, 72 for lower eyelid roll (fullness), 33
American Academy of Facial Plastic and Recon- overview of, 2, 4t
structive Surgery, 8 preparation (reconstitution) of, 5
American Society for Aesthetic Plastic Surgery, 8 for smoker’s lines, 48
American Society for Dermatologic Surgery, 8 Botulinum toxin A formulations
American Society of Ophthalmic Plastic and comparison of, 4t
Reconstructive Surgery, 8 overview of, 2–4
American Society of Plastic Surgeons, 8 preparation (reconstitution) of, 5
Anesthesia techniques, 96–99 Botulinum toxin A injections
Angular artery adjunctive use of, with lip filler injections, 115
in medial midface hollowing treatment, 149, for bunny lines, 34–37
150f for dimpled chin, 54–56
in nasolabial fold injections, 104 for forehead wrinkles, 16–21, 125
in sunken cheeks treatment, 158f for glabellar frown lines, 10–15, 122–124
Anterograde injections, of fillers, 100, 102f for “gummy” smile, 50–53
for lip augmentation, 115, 116f for gustatory sweating (Frey) syndrome, 74–75
Antiviral therapy, 115, 182 for lateral brow lift, 17, 26–28
Apraclonidine, 89 for lip lift, 45–46
Armpits, profuse sweating of, 76–79, 77f, 78f for lower eyelid roll, 32–33, 33f
Arrhythmias, local anesthetic injection-related, for masseter muscle hypertrophy, 66–68
98 for migraine headaches, 84–87, 85f, 86f
Artefill. See Polymethylmethacrylate injections for nasal flare, 40–41
Asian patients, hypertrophic masseter muscle for nasal tip lift, 38–39
enlargement in, 66 for necklace lines, 60–62
195
196 Index
Botulinum toxin A injections (continued) mental crease augmentation-related, 165
for Nefertiti neck lift, 62–65 nasolabial fold injections-related, 105
for oral commissure elevation, 42–44 oral commissure elevation-related, 119
for parotid gland hypertrophy, 69–71 sunken upper eyelid treatment-related, 132
for platysmal banding, 57–59, 60 tear trough deformity treatment-related, 128
for profuse sweating vertical lip line treatment-related, 121
of feet, 82–83, 83f Bruxism, 66
of hands, 80–81, 81f BTXA, overview of, 3, 4t
of underarms, 76–79 Buccal region, as filler injection site, 156–157, 158f
for smile lines and crow’s feet, 22–25, 181 Bulimia, as parotid gland hypertrophy cause, 69
for smoker’s lines, 47–49 Bunny lines, 34–37
for submandibular gland hypertrophy, 72–73 botulinum toxin A treatment for, 34–37, 36f
Botulinum toxin injections definition of, 34
action mechanism of, 2 Bupivacaine, as arrhythmia cause, 98
duration of clinical effect of, 88
level of difficulty of, 190–191 C
for “liquid” facelift, 180–181, 181f Calcium hydroxylapatite (CaHA), 92, 93
overview of, 2–4, 4t Calcium hydroxylapatite injections
preparation of, 5 for acne scars, 171
Bovine collagen for aging hand rejuvenation, 173–174
allergy to, 94 Food and Drug Administration approval for, 95t
disadvantages of, 92 injection technique, 93
Food and Drug Administration approval for, 95t for jawline rejuvenation, 167
polymethylmethacrylate microsphere suspen- for lateral malar prominence augmentation,
sions in. See Polymethylmethacrylate (PMMA) 153
Brow for medial midface hollowing, 149, 150–151
ptosis of for nasal valve stenting, 147
botulinum toxin injection-related, 88, 125 for nasolabial folds, 105, 106
chemical browlift for, 29–31, 31f for nonsurgical rhinoplasty, 141
compensation for, 17 precautions regarding, 93
filler injection treatment for, 134–136, 136f for sunken temples, 138
in forehead wrinkle treatment, 17 Canadian Society for Aesthetic Plastic Surgery, 8
resting position of, 17 Cheekbone augmentation, filler injections for,
Brow injections, lateral, for migraine headache 152–155, 154f
treatment, 84 Cheeks
Brow lift “apple,” 104
chemical, 29–31, 31f sunken, filler injections for, 156–159, 158f
lateral, 17, 26–28, 28f Chemical peel, of perioral lines, 121
filler injections for, 134–136, 136f Chewing disorders, post-botulinum toxin injection-
Brow position, in men and women, 16 related, 67
Bruising, post-botulinum toxin injection, 11, 17, Chin
22–23 alloplastic implants for, 160, 161
bunny lines treatment-related, 35 augmentation with filler injections, 160–163,
lateral brow lift-related, 26–27, 30 162f
lower eyelid roll treatment-related, 33 cleft, 162f
parotid gland hypertrophy treatment-related, 70 dimpled (“peau d’orange”), 54–56, 56f, 165
submandibular gland ptosis treatment-related, 73 Chin crease. See Mental crease
Bruising, post-filler injection Collagen injections. See also Bovine collagen;
aging hand rejuvenation-related, 174 Human collagen; Porcine collagen
chin augmentation-related, 161 for acne scar treatment, 171
facial volumizing (Sculptra)-related, 177 Columella, horizontal crease below, 52f
jawline rejuvenation-related, 167 Complications
lateral brow lift-related, 135 of botulinum toxin injections, 88–89, 89f
lateral malar prominence augmentation-related, of filler injections, 182–187
153 Corrugator muscles, hyperactivity of, 29
lip augmentation-related, 115 Corrugator supercilii muscle
marionette line treatment-related, 112 anatomy and function of, 11, 12f
medial midface hollowing treatment-related, contraction of, 10
149, 150 origin site of, 10
Index 197
Corrugator supercilii muscle injections Eyelids
for glabellar frown lines, 10–15, 13–15f lower
for lateral brow lifts, 29, 31f fat herniation of, 33
positioning patterns of, 10 preexisting laxity of, 32
Cross-hatching injection technique, 101, 102f roll (fullness) of, 32–33, 33f
for facial volumizing (Sculptra), 179f Tyndall effect on, 186f
for nasolabial folds, 105 upper
for polymethylmethacrylate filler use, 108 botulinum toxin-related ptosis of, 11, 17,
for vertical lip lines treatment, 120, 121f 88–89, 89f
Crow’s feet, botulinum toxin A treatment for, orbicularis oculi muscle injection-related lag
22–25, 181 of, 23
injection technique in, 23–25, 24f sunken, 131–133, 133f
precautions regarding, 22
F
D Face lift, “liquid,” 180–181, 181f
Dental blocks Face lift surgery, lower, 58
contraindication to, 152 Facial artery, 72, 184f
for lip filler injections, 114 Facial mimetic muscles, 75
for mental crease filler injections, 164 Facial nerve, 69, 72
technique of, 97, 98 Facial vein, 72
Depot injection technique Facial volumizing (Sculptra), 176–179, 179f
for chin augmentation, 160 Fainting, epinephrine-related, 98
for facial volumizing (Sculptra), 177, 179f Fanning injection technique, 100–101, 102f
for forehead wrinkles, 125, 126f for chin augmentation, 160–161
for mental crease augmentation, 164 for facial volumizing (Sculptra), 177, 179f
for oral commissure elevation, 119f for marionette lines, 112f
with polymethylmethacrylate fillers, 108 for medial midface hollowing, 149
for sunken temples, 137–138 for nasolabial folds, 105
Depressor anguli oris muscle, in marionette line for oral commissure elevation, 119f
treatment, 111 for sunken cheeks, 156–157, 158f
Depressor anguli oris muscle injections, 119 Fat augmentation
for oral commissure elevation, 42–44 of the aging face, 176
Depressor labii inferioris muscle, in “Nefertiti of the lateral malar prominence, 152
neck lift” procedure, 63, 65f Feet, profuse sweating of, 82–83, 83f
Depressor septi nasi muscle injections, 38–39, Ferning injection technique, 101, 102f
39f Fever blisters, 115
Dermabrasion, for perioral lines, 121 Filler injections, facial, 91–95, 100–102
Dilator nasalis muscle injections, for nasal flare for acne scars, 170–172, 172f
correction, 40–41, 41f for aging hands rejuvenation, 173–175, 175f
Drooling, post-botulinum toxin injection, 55 for cheekbone or malar prominence augmen-
Drool lines. See Marionette lines tation, 152–155, 154f
Dry eye, 33, 89 for chin augmentation, 160–163, 162f
Dysphagia, 58, 63 complications of, 182–187
Dysphonia, 58 for earlobe rejuvenation, 168–169, 169f
Dysport for facial volumizing (Sculptra), 176–179, 179f
for glabellar frown lines, 11 Food and Drug Administration-approved, 95t
overview of, 2, 4t for forehead wrinkles, 125–127, 126f
preparation (reconstitution) of, 5 for glabellar frown lines, 122–124, 124f
for smile line and crow’s feet, 23 indications for, 104
injection techniques for, 92
E for jawline rejuvenation, 166–167, 167f
Earlobe rejuvenation, 168–169, 169f for lateral brow lifts, 134–136, 136f
Ela-Max, 97 level of difficulty of, 190–191
“Elvis snarl and muscle,” 50 for lip augmentation, 46, 114–117, 116f
Embolism, 122, 145, 178 for “liquid” facelift, 180–181, 181f
EMLA (eutectic mixture of local anesthetics), 97 for marionette lines, 94, 108, 110f, 111–113, 112f
Epinephrine, 97 for medial midface hollowing, 149–151, 150f
sensitivity to, 98 in the mental crease, 164–165, 165f
Erythema, filler injection-related, 183 for nasal valve stenting, 146–148, 147f
198 Index
Filler injections, facial (continued) H
for nasolabial folds, 104–107, 106f HA. See Hyaluronic acid
for nonsurgical rhinoplasty, 140–145, 142–144f Hand muscles, post-botulinum injection weakness
“off-label,” 92 of, 81
for oral commissure elevation, 118–119, 119f Hands
overview of, 92–95 aging, filler injection-based rejuvenation of,
precautions regarding, 93 173–175, 175f
for smoker’s lines, 49 profuse sweating of, 80–81, 81f
for sunken cheeks, 156–159, 158f Headaches, post-injection, 11, 88
for sunken temples, 137–139, 139f Hematomas
for sunken upper eyelids, 131–133, 133f post-botulinum toxin injection, 70, 72, 73
for tear trough deformity, 128–130, 130f post-filler injection, 174, 178
techniques, 92, 103–107 Hemorrhage, submandibular gland ptosis
for vertical lip lines, 120–121, 121f treatment-related, 72
Fluoroquinolones, 183 Herpetic outbreak, filler injection-related, 182, 186f
5-Fluorouracil, 183 HIV patients, parotid gland hypertrophy in, 69
Flute playing, 45–46, 47 Human collagen, as facial filler, 95t
Food and Drug Administration approval, of Hyaluronic acid
injectable materials, 8, 10, 85, 92 composition of, 92
Forehead, volume loss in, 29 Food and Drug Administration approval for, 92,
Forehead injections, for migraine headache 95t
treatment, 84 types of, 92
Forehead wrinkles. See also Glabellar frown lines Hyaluronic acid injections, 92–93
botulinum toxin injection treatment for, 16–20 for acne scar treatment, 170–171
combined with filler injections, 126 for aging hand rejuvenation, 173–174
injection techniques, 16–20, 18–20f as delayed hypersensitivity cause, 185f
precautions regarding, 17 for earlobe rejuvenation, 168, 169f
filler injections for, 125–127, 126f for glabellar frown lines, 122–124, 124f
combined with botulinum toxin injections, for jawline rejuvenation, 166–167, 167f
126 for lateral malar prominence augmentation, 153
Frey syndrome, 74–75, 75f for medial midface hollowing, 149, 150–151
Frontalis muscle for mental crease augmentation, 164–165
anatomy and function of, 16, 17 for nasal valve stenting, 147
in brow ptosis, 17 for nasolabial folds, 105, 106
in glabellar frown line treatment, 13f, 14f, 15f for nonsurgical rhinoplasty, 141–145, 142–144f
resting tonic contractions of, 17 for oral commissure elevation, 42, 43, 118–119
Frontalis muscle injections precautions regarding, 93
for forehead wrinkles, 16, 17–18, 18–20f premixed with lidocaine, 92
injection technique, 16 for sunken temples, 137–138
for lateral brow lifts, 27, 28f, 29, 30, 31f for sunken upper eyelids, 131–133, 133f
for tear trough deformity, 128–130, 130f
G Tyndall effect of, 93, 105, 112, 119, 129, 130f,
Galea aponeuritica, 16 164–165, 171, 182
Gate theory, of pain, 98 for vertical lip lines, 120–121, 121f
Glabellar injections Hyaluronidase injections, as Tyndall effect treat-
for frown lines, 10–15, 18, 122–124, 123, 124f ment, 129, 182
anatomic considerations in, 10, 12f Hypersensitivity delayed, filler injection-related,
combined with filer injections, 122, 123 183, 185f
injection techniques, 11–15, 13–15f
persistent frown lines after, 123 I
precautions regarding, 11 Ice, for anesthesia, 96
for lateral brow lifts, 29–30 IncobotulinumtoxinA, overview of, 2, 4t
for migraine headache treatment, 84 Informed consent
as upper eyelid ptosis cause, 89f for botulinum toxin injections, 191
Glabellar rhytids, horizontal, bunny lines related, 34 for filler injections, 193
Granulomas, filler injections-related, 183 Infraorbital nerve, 149, 150f, 154f
Grid pattern injection technique, 101, 102f Infraorbital nerve blocks, 96, 128, 152
for facial volumizing (Sculptra), 177, 179f Infraorbital rim. See Orbital rim, infraorbital
“Gummy smile” treatment, 50–53, 51f, 52f Injectable materials, safety considerations for, 8
Index 199
Injectors, training of, 8 pursing of, 48, 120
for poly-L-lactic acid us, 176–177, 178 in smoker’s lines treatment, 48–49, 49f
Instrumentation, for botulinum toxin A injections, vertical lines of, 120–121, 121f
6, 7f Lip lifts, 45–46, 46f
Insulin syringes, for botulinum toxin A injections, Lipoatrophy, of the aging face, 176
6, 7f Luer locks, 6
International Federation of Facial Plastic Surgery
Societies, 8 M
International Society of Aesthetic Plastic Surgery, 8 Macrolide antibiotics, 183
Interosseous muscles, in hand filler injections, 173 Malar implants, permanent, 152
Intravascular injections. See also Vascular injuries “Malar mound.” See Malar prominence
with poly-L-lactic acid, 178 augmentation
in submandibular gland ptosis treatment, 72, 73 Malar prominence augmentation, filler injections
in sunken upper eyelid treatment, 131, 132 for, 152–155, 154f
Iopidine, 0.5%, 89 Male patients
botulinum toxin A dosages for, 16
J brow position in, 16
Jawline rejuvenation, with filler injections, Mandible. See also Jawline rejuvenation; Jowls
166–167, 167f in masseter muscle hypertrophy treatment, 68f
Jowls Mandible injections, in Nefertiti neck lift procedure,
facelift treatment for, 166 63, 65f
formation of, 156, 166 Mandibular border, width narrowing procedure for,
Juvéderm, 115, 171 66–68, 68f
Mandibular notch, in parotid gland hypertrophy
K treatment, 69
Kenalog, 183 Marionette lines
definition of, 111
L filler injections for, 94, 108, 110f, 111–113,
Laser resurfacing, of perioral lines, 121 112f
Levator labii superioris alaeque nasi muscle Masseter muscle
anatomy and function of, 50 in gustatory sweating (Frey) syndrome, 75
in “bunny lines” treatment, 35, 36f hypertrophy of, 66–68, 68f
in nasal flare correction, 41f Melolabial groove. See Marionette lines
Levator labii superioris alaeque nasi muscle Mental crease
injections, for “gummy smile,” 50–52, in dimpled chin treatment, 55, 56f
51f, 52f filler injections for, 164–165, 165f
Levator labii superioris muscle, in “bunny lines” Mental foramen
treatment, 36f in chin augmentation, 161, 162f
Levator palpebrae superioris muscle in jawline rejuvenation, 167
in glabellar frown line treatment, 11, 13–15f Mentalis muscle injections, for dimpled chin,
in lateral brow lifts, 27, 28f, 30, 31f 54–56, 56f, 165
Lidocaine, 96 Mentalis muscles, anatomy and function of, 164
as EMLA component, 97 Mental nerve
as epinephrine alternative, 98 in chin augmentation, 161
fatal overdoses of, 98 in jawline rejuvenation, 167f
in filler injections, 94, 95t, 114–115, 177 Mental nerve blocks, 96
in regional nerve blocks, 97 “Mephisto” (devilish) sign, 17, 20f
topical intraoral, 98 Metacarpal bones, in hand filler injections, 173
Lids. See Eyelids Midface, medial hollowing of, filler injections for,
Lightheadedness, epinephrine-related, 98 149–151, 150f
Linear threading injection technique Migraine headache treatment, 84–87, 85f, 88
for facial volumizing (Sculptra), 177 trigger points in, 84–85, 86f
for mental crease filling, 164 Mini-mucosal nerve blocks, 96
for nasolabial folds, 105 Mouth. See also Lip(s); Oral commissures
for vertical lip lines, 120 asymmetric, 48, 49
Lip(s) injections around
anesthetization of, 97 precautions regarding, 45–46
augmentation with fillers, 114–117, 116f, 181 for smoker’s lines correction, 48–49, 49f
drooping, 55, 63 “Mr. Spock” sign, 17, 20f
200 Index
Müller’s muscle stimulation, as eyelid ptosis contraindication as poly-L-lactic acid injection
treatment, 88–89 site, 178
Myobloc, overview of, 3, 4t hypertrophy of, 32–33, 33f
differentiated from lower eyelid fat herniation,
N 33
Naphazoline, combined with pheniramine, 89 lateral, hyperactivity of, 26–28, 28f, 29
Naphcon A, 89 orbital, 32
Nasal flare, 40–41, 41f in tear trough deformity treatment, 128, 130f
Nasalis muscle, in nasal flare treatment, 41f Orbicularis oculi muscle injections
Nasalis muscle injections, for bunny lines for hypertrophic orbicularis oculi muscle, 32–33,
treatment, 34–37, 36f 33f
Nasal tip, drooping for lateral brow lifts, 26–28, 28f, 29–31, 31f, 135
filler injections for, 141, 144f for smile lines and crow’s feet treatment, 22–25,
tip lift for, 38–39, 39f 24–25f
Nasal valve stenting, filler injections for, 146–148, Orbicularis oris muscle
147f anatomy and function of, 45, 48
Nasolabial angle, 38 contraction of, as circumoral rhytid cause, 120
“Nasolabial fold-free” face, 104 contraindication as poly-L-lactic acid injection
Nasolabial folds site, 178
in facial volumizing (Sculptra), 177, 179f in dimpled chin treatment, 55, 56f
filler injections for, 94, 104–107, 106f, 108–110, Orbicularis oris muscle injections, for lip lift,
109f, 186f 45–46, 46f
in Nefetiti neck lift, 63 Orbital rim
in sunken cheeks treatment, 156, 158f infraorbital rim
Necklace lines treatment, 60–61, 61f in lateral malar prominence augmentation, 154f
Neck lift in tear trough deformity treatment, 128–129,
Nefertiti, 62–65, 64f, 65f 130f
ptotic submandibular glands appearance lateral
following, 72 in facial volumizing (Sculptra), 177
surgical, 58 in lateral browlift, 136f
Necrosis, nonsurgical rhinoplasty-related, 145 in orbicularis oculi muscle injections, 23, 24f, 25f
Needle injections, as pain cause, 96 superior, as filler injection site, 131–132, 133f
Needles, for injectable filler use, 92
Nefertiti, Queen, 62, 64f P
Nefertiti neck lift procedure, 62–65, 64f, 65f Palpebral aperture, widening of, 32, 33f
Nerve blocks Parotidectomy, superficial, as gustatory sweating
dental. See Dental nerve blocks cause, 74
regional. See Regional nerve blocks Parotid gland, hypertrophy of, 69–71, 71f
Neuronox, overview of, 3, 4t “Peau d’orange” chin, 54–56, 56f, 165
Neurotoxins. See Botulinum toxins Periocular area, venous structure of, 22–23
Nodules, filler injections-related, 177–178, 183 Perioral region
Nonsteroidal anti-inflammatory drugs, as biofilm smoker’s lines of, 48–49, 49f
cause, 183 vertical lines of, 120–121, 121f
Nose, twisted/crooked, 141, 143–144f Pharyngeal muscles, relationship to submandibular
Nostrils, flaring of, 40–41, 41f glands, 72
“No Waste” syringes, 6, 7f Pheniramine, combined with naphazoline, 89
Philtral columns, filler augmentation of, 46f, 114,
O 115, 116f
Occipitofrontalis muscle injections, for migraine Physician Coalition for Injectable Safety (PCIS), 8
headache treatment, 86f Platysmal bands
OnabotulinumtoxinA (BoNTA). See Botox botulinum toxin treatment for, 57–59, 59f
Ophthalmic artery, embolization of, 122 definition of, 57
Oral commissures in Nefertiti neck lift procedure, 62–63, 65f
in lip augmentation, 115 Platysma muscles, anatomy and function of, 57,
in marionette line treatment, 112f 62, 69
in smoker’s lines treatment, 49 PLLA. See Poly-L-lactic acid
Oral commissures elevation, 42–45, 118–119, 119f PMMA. See Polymethylmethacrylate
Orbicularis oculi muscle Poly-L-lactic acid, composition of, 94
anatomy and function of, 22, 26, 32 Poly-L-lactic acid injections, 92, 94
Index 201
for aging hands rejuvenation, 174 Retrograde injection technique, 100, 102f, 108
for earlobe rejuvenation, 168 for lip augmentation, 116f
for facial volumizing (Sculptra), 176–179, 179f for nonsurgical rhinoplasty, 145
Food and Drug Administration approval for, 92, Rhinoplasty, nonsurgical filler injection technique
95t of, 140–145
injection techniques, 94, 176–177 for dorsal hump straightening, 141, 142f
precautions regarding, 94, 177–178 for drooping nasal tip correction, 141, 144f
preparation (reconstitution) of, 176–177 injection technique, 140–141, 142–144f
for sunken cheeks, 157 for saddle nose deformity correction, 141,
for sunken temples, 138 142–143f
Polymethylmethacrylate, 92 for twisted/crooked nose correction, 141,
composition of, 93 143–144f
properties of, 93 as vascular injury cause, 185f
uses of, 94 RimabotulinumtoxinB (Myobloc), 3, 4t
Polymethylmethacrylate injections Risorius muscle, in masseter muscle hypertrophy
for acne scars, 171 treatment, 68f
Food and Drug Administration approval for, 92,
95t S
for jawline rejuvenation, 167 Saddle-nose deformity, 141, 142–143f
for marionette lines, 108, 110f Saline, for botulinum toxin A preparation
for nasolabial folds, 105, 106, 108–110, 109f (reconstitution), 5
precautions regarding, 94 Saliva secretion, 74
Porcine collagen, as facial filler, 95t Sculptra (facial volumizing), 176–179, 179f
Posterior tibial nerve blocks, 82 Sentinel vein, 134, 136f
Povidone iodine (Betadine), 74–75 Serial puncture injection technique, 100, 102f
Prejowl sulcus, augmentation of, 166–167, 167f for forehead wrinkle treatment, 126f
Prilocaine, as EMLA component, 97 for nasolabial folds, 105
Procerus muscle Smile. See also “Gummy smile” treatment
contraction of, 10 after oral commissure elevation, 118–119
in glabellar frown line treatment, 13–15f asymmetric, 23, 45, 49
hyperactivity of, 29 Nefertiti neck lift-related, 63
origin site of, 10 Smile lines, botulinum toxin A treatment for,
Procerus muscle injections, for lateral brow lifts, 22–25
29, 31f Smoker’s lines, 47–49
Pterygoid muscles, lateral, in parotid gland Smoking, as perioral wrinkle cause, 120
hypertrophy treatment, 69 Snap test, 33
Ptosis Speech disorders, botulinum injection-related, 67
brow Starch-iodine test, 74–75, 75f, 76, 77f, 78f
botulinum toxin injection-related, 88, 125 Steroids, as biofilm cause, 183
chemical brow lift for, 29–31, 31f Submalar region, as filler injection site, 156–157,
compensation for, 17 158f
filler injection treatment for, 134–136, 136f Submandibular gland injections, combined with
in forehead wrinkle treatment, 17 platysmal band injections, 58
eyelid Submandibular glands, ptosis or hypertrophy of,
botulinum toxin injection-related, 88–89, 89f 72–73, 73f
corrugator supercilii muscle infection-related, Superficial musculoaponeurotic system (SMAS), 57,
11 60, 69, 180
forehead wrinkle treatment-related, 17 Supraorbital artery
nasal, 38–39 in glabellar filler injections, 122, 124f
of submandibular glands, 72–73, 73f in upper eyelid filler injections, 131, 133f
Purpura, facial artery occlusion-related, 184f Supraorbital blood vessels, 122
Purtox, overview of, 3, 4t Supraorbital nerve, in upper eyelid filler injections,
131, 133f
R Supraorbital rim, in frontalis muscle injections, 18f
Regional nerve blocks. See also names of specific Supratrochlear artery
nerves in glabellar filler injections, 122, 124f
for botulinum toxin injections, 80, 82 in upper eyelid filler injections, 131, 133f
for filler injections, 92, 94, 96, 97 Supratrochlear nerve, in upper eyelid filler
Restylane, 141, 171 injections, 131, 133f
202 Index
Sural nerve blocks, 82 Tyndall effect, 93, 105, 112, 119, 129, 130f, 164–165
Swallowing dysfunction, post-botulinum injection, definition of, 93
57, 60, 61, 67, 70, 72 treatment for, 182
Sweating, profuse
of the feet, 82–83, 83f U
gustatory (Frey syndrome), 74–75, 75f Underarms, profuse sweating of, 76–79, 77f, 78f
of the hands, 80–81, 81f
of the underarms, 76–79, 77f, 78f V
Syringes, for botulinum toxin A injections, 6, 7f Valtrex, 182
Vascular injuries, filler injection-related, 93, 94,
T 109, 126, 151, 183, 184–185f
Tachycardia, epinephrine-related, 98 Vermilion border injections, 48
Tear trough, in facial volumizing (Sculptra), for lip augmentation, 114, 115, 116f
177 for lip lift, 45
Tear trough deformity, filler injections for, for smoker’s lines, 47
128–130, 130f for vertical lip lines treatment, 120–121, 121f
Temple Vitrase, 182
anatomic boundaries of, 137
sunken, filler injections for, 137–139, 139f W
Temporal fossa, hollowing of, filler injections for, Whistling, 45–46, 48
137–139, 139f Wind instrument musicians, 45–46, 48, 51
Temporalis muscle, in masseter muscle
hypertrophy treatment, 67 X
Temporalis muscle injections Xeomin, 2, 4t, 5
for migraine headache treatment, 84, 86f Xerostomia, as parotid gland hypertrophy cause, 69
for sunken temples, 137, 139f Xylocaine, 132, 146
Tetracaine, 97
Threading injection technique Z
for chin augmentation, 160–161 Zygomatic arch
for jawline rejuvenation, 166–167 in lateral malar prominence augmentation, 154f
Tongue movement disorders, submandibular gland in sunken cheeks treatment, 156, 157, 158f
ptosis treatment-related, 72 in sunken temple treatment, 139f
Topical anesthesia/anesthetics, for filler injections, Zygomaticomalar region, 152, 154f
92, 93, 94, 96, 97 Zygomaticus major muscle, in orbicularis oculi
Trapezius muscle injections, for migraine headache muscle injections, 23, 24f, 25f
treatment, 84–85, 86f Zygomaticus muscle
Trigeminal nerve, anatomy and function of, in masseter muscle hypertrophy treatment, 68f
96, 99f in oral commissure elevation, 42
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