DERMAL FILLERS

TECHNIQUES OF FILLING WITH HYALURONIC ACID IN AESTHETIC MEDICINE

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 DERMAL FILLERS TRAINING COURSE
(1 day hands on training)

Course Pre-requisite
_______________

1. Must have level 3 Diploma in Beauty Therapy General / Treatments or equivalent

2. Have at least 3 years of experience performing advanced beauty procedures
3. Must be trained in first Aid and Anaphylaxis shock treatment
4. Pre-requisite for Injecting
 AGING PROCESSES

I. Aging associated with age; chronological:

- weakening of the protective function of the skin – dry skin, reduced production of sebum
- a drop in the number of metabolically active fibroblasts (collagen, elastin, GAG)
- a drop in the number of keratinocytes – reduction of the number of living layers of the epidermis
- a drop in the number of Langerhans cells – reduction of skin’s immunity
- a drop in the number of melanocytes and melanosomes – reduction in pigmentation
- impairment of vitamin D synthesis
- flattening of the dermal-epidermal junction
- diminishing of the diameter of cutaneous capillaries without reducing the density of the vascular network
- impairment of blood supply to hair follicles and nail beds (atrophy)
- loss of tension and flexibility, no ability to re-smooth
- the emergence of excess skin – resorption of bone tissue, muscular tissue, we lose support

- thinning and significant reduction in skin moisture

- excess of skin caused by the loss of bone and muscle tissue of the face
- bags under eyes – weakening of the bone portion of the eye socket and bringing out adipose tissue
- lowering of eyebrows – smaller eyes, tired look
- lowering of the tip of the nose
- disappearance of bone tissue of the mouth area, disappearance of the red zone of the lip and thinning of the lips
- lowering of the cheeks – less marked cervical-mandibular line the mouth area, disappearance of the red zone
of the lip and thinning of the lips
- distortion of the lower outline of the jowl
- reduction of laryngeal cartilage and bone – bringing out of the thyroid cartilage

II. Aging caused by external factors:

- telangiectasia – thickening of capillary walls, chronic perivascular inflammation

- increased dryness with visible exfoliation
- preneoplastic changes
- seborrheic keratosis, keratolytic changes
- malignant neoplastic lesions

1. Cheekbones

1 2. Cheeks
2
3 3. Nasolabial folds

4. Marionette lines
4
5. Jowl

5 6. Chin
6
CHARACTERISTICS, TYPES AND EFFECTS OF HYALURONIC ACID

Structure and characteristics of hyaluronic acid

Hyaluronic acid (HA) belongs to the group of compounds known as glycosaminoglycans (GAGs). They are
polysaccharides made up of many repeating units of disaccharides. The HA disaccharide molecule consists of a
D-glucuronic acid molecule and an N-acetylglucosamine molecule linked via alternating glycosidic bonds.
Hyaluronic acid is a natural compound that has the same chemical structure in humans as in other vertebrates
and bacteria. In living organisms, it usually occurs in the form of a sodium salt – sodium hyaluronate. Hyaluronic
acid exhibits many properties that are important in numerous applications. One of them is the ability to bind large
amounts of water. This is possible thanks to the anionic structure of the acid, which has the effect of attracting
various cations. The compound is characterized by high osmotic activity, which in turn makes it possible to attract
significant amounts of water through osmosis. As an example, when the concentration of hyaluronic acid in the
solution reaches 0.1 mg/ml, one molecule of acid is able to bind even up to 1 liter of liquid. Without taking into
account space limitations, it would result in a 1000-fold enlargement of its volume. Due to its polymeric nature,
HA has interesting viscoelastic properties. The feature of hyaluronic acid called biocompatibility results from
the fact that it occurs naturally in the skin, so it causes few adverse reactions of the body.

Occurrence and functions of hyaluronic acid

It is estimated that in an adult person with a body weight of 70 kg, there is approximately 15 g of HA in the form
of sodium hyaluronate. It can be completely absorbed by the body, which is an unquestionable advantage when
using it as an implant in cosmetology. Almost half of the hyaluronic acid occurring in the human body is found in
the skin, and most of it is present in the intercellular space. It is estimated that human dermis contains 200-500
g/ml of HA, while the epidermis holds 100 g/ml. Hyaluronic acid, in addition to being a matrix where cells are
embedded, plays the role of a water-binding compound, affecting the volume and compressibility of the skin. It
can increase tissue resistance to mechanical stress by binding and retaining water in intercellular spaces. It also
plays a role in capturing free radicals that are formed as a result of ultraviolet radiation.
 WHAT ARE DERMAL FILLERS?

• Dermal Fillers are composed of Non-Animal Stabilised Hyaluronic Acid, which is a biodegradable
substance that naturally degrades out of the body over time.
• Hyaluronic acid - occurs naturally in the deeper layers of our skin (the dermis). It helps to keep skin "plump" and
has ability to hold up to 1,000 times its weight in water. As we get older our bodies produce less and less
hyaluronic acid. The ageing starts at around the age of 40,and the downward slide becomes apparent as the
skin starts to lose its elasticity and lines and wrinkles appear.
• Hyaluronic acid in the skin supports the collagen and elastin hence having the Dermal Fillers is good to prevent
skin ageing long term.

EXAMPLE BRAND - WHAT IS PERFECTHA

• Perfectha is the Latest Generation of Hyaluronic Acid Filler, from France. They are easy to inject with long lasting
volumizing effect, for the treatment of wrinkles and volume loss.
• Perfectha is the latest highly hyaluronic acid gel for facial wrinkles.

PRODUCT PROFILE: PERFECTHA

1. Hyaluronic Acid
2. Non-animal origin produced by fermentation with lab modified bacteria.
3. 90% of cross-linked gel and 10% of Free HA
4. Duration— Lasts between 6-18 months
5. ie Complement/Derm lasts up to 6 months and Subskin up to 18 months

Action of Hyaluronic acid in skin metabolism:

1. Increases water-binding capacity

2. Influences cell activity
3. Protects cells from free radicals
4. Has anti-inflammatory properties
5. Promotes wound healing

The types of Dermal fillers on the market can be differentiated according to:

1. The concentration of HA
2. The molecular weight
3. The degree of cross-linking ie. the more cross linked the longer they last and the thicker they are
4. Juvederm is less cross linked than Perfectha, hence the Perfectha lasts results last much longer

PRODUCT SPECIFICATIONS:

Product Percentage Non cross-linked HA Percentage Cross-linked HA

Perfectha Complement 30% 70%
Perfectha Derm 10% 30%
Perfectha Deep 10% 30%
Perfectha Subskin 10% 30%
 CROSS LINKING

1. An unique cross-linking technology allowing the formation of (C=O) by hydrogen bonds within and between
hyaluronic acid particles providing a 3D structure.
2. 90% cross-linked and 10% non cross-linked HA
3. The concentration of hyaluronic acid.
4. The degree of cross-linking, which affects longevity and stability.
5. The gel hardness, which helps determine flow properties, the extrusion force required, and the structure and
stiffness of the finished product.
6. The degree of gel swelling, or ability to resist dilution, which also influences longevity.

Resistance against distortion increases the lifting effect.

The degree of cross-linking is the percentage of disaccharide monomers that are bound by the cross-linking
molecule (e.g. 4% means that on average there are 4 cross-linking molecules per 100 disaccharide monomers).
The higher the level of cross-linking, the harder the gel and the longer its retention in the skin. Too high
cross-linking reduces the attraction of water to polymers and its filling capacity. It can also affect the product’s
biocompatibility and induce immune reactions (granulomas!!!)
Cross-linking serves the volume through its insolubility in water. The following ingredients are used as
cross-linking agents:
• 1,8-diepoxy acetate (DEO)
• divinyl sulphone (DVS)
• 1,4-butanediol diglycidyl ether (BDDE).

Preparations cross-linked with DEO are more resistant to enzymatic degradation because they
cross-link through both ether and ester bonds.

After cross-linking, the entire resulting gel is broken down into particles and mixed with water or
non-cross-linked hyaluronic acid in order to allow for an injection with a thin needle. These are two-phase fillers.
The following rules apply to them:
The smaller the particles, the easier the material degrades and the shorter the filling effect.
Preparations with small particles and low viscosity are administered superficially.
Preparations with large particles and high viscosity are administered deep.

Through cross-linking, products acquire different properties:

• Water binding capacity increases with the degree of cross-linking
• High degree of cross-linking slows down the degradation process, extending the filling effect
• Cross-linking makes injection more difficult
• Side effects due to toxicity of cross-linking agents may occur

Disinfectants such as benzalkonium chloride or the tools for which they were used must never
come into contact with the preparations because the acid will then precipitate!
PRODUCT USEGE

Fine Lines Derm Deep SubSkin

Lips contour, Deep wrinkles Cheeks, Chin

Treatment areas Fine Lines Lip lines lip volume Marionette Lines,
Nasolabial folds

Injection site Superficial dermis Middle dermis Deep dermis Subcutaneous

Syringe 0.5ml 1ml 1ml 3ml

# of gel particles/ml 180,000 90,000 8,000 2,000

Lasts 4-6 months 6-12 months 8-12 months 12-18 months

Needle size 30G * 1/2" 30G * 1/2" 27G * 1/2" 27G/canule

 PRODUCT DESCRIPTION

1 PERFECTHA FINE LINES (FOR FINE LINES AND SUPERFICIAL WRINKLES)

• Inject in the superficial dermis.
• Injection sites: Superficial wrinkles - crow’s feet
• HA Origin: Non Animal
• Number of gel particles- 180 000
• Crosslinking Rate: 90%
• Lasts: Between 4 to 6 months
• Needle size: 30G * 1/2"

2 PERFECTHA DERM (FOR MEDIUM LINES AND LIP CONTOUR)

• Inject in the Medium dermis.

• Injection sites: Upper lip wrinkles/Lips
• HA Origin: Non Animal
• Number of gel particles- 90 000
• Crosslinking Rate: 90%
• Lasts: Between 6 to12 months
• Needle size: 30G * 1/2"
• Storage away from frost and light: between 2°C and 30°C

3 PERFECTHA DEEP (FOR DEEP WRINKLES AND LIP AUGMENTATION)

• Inject in the deep dermis

• Volume: 1ml
• Injection sites: deep wrinkles, Lip Volume
• HA Origin: Non Animal
• Number of gel particles- 8000
• Crosslinking Rate: 90%
• Lasts: Between 8 to 12 months
• Needle size: 27G * 1/2"

4 PERFECTHA SUBSKIN (JAW, CHIN, MARIONETTE LINES, CHEEKS, NASOLABIEL FOLDS)

• Inject in the Subcutaneous Layer

• Volume: 3ximl or 1x3mi
• Injection sites: Face contour, acne scarring
• HA Origin: Non Animal
• Number of gel partides- 2,000
• Crosslinking Rate: 90%
• Lasts: Between 12 to 18 months
• Needle size: 27G * 1/2"
• Storage away from frost and light, between 2°C and 30°C
5 PERFECTHA COMPLEMENT

• Volume: 0.8 mi
• Injection sites: Complement after Botox , SKIN Hydration and Décolleté rejuvenation
• Number of gel particles/mL: 180 000
• Crosslinking Rate: 70%
• Lasts: Between 4 to 6 months
• Needle size: 30G x 1/2)
• Storage away from frost and light, between 2°C and 30°C

DIFFERENCES BETWEEN THE PRODUCTS:

1. Size of gel particles/ml, leading to differences in viscosity, in injected volumes, in indications, in injection
sites and in product duration.
2. Hyaluronic Acid
3. Non animal origin HA, produced by fermentation - modified bacteria produced in the lab.
4. Latest generation of cross-linked HA.
5. Cross-linked- 90 % cross-linked and 10% free HA
6. Duration of action 6-18months
7. All Production is 100% made in France

MAIN INDICATIONS OF PERFECTHA

FINE LINES COMPLIMENT DERM DEPEP SUBSKIN

FINE LINES HYDRATION Medium wrinkles, Lip volume Volumising and

Upper lip and lips deep wrinkles support, cheek
bone,chin, jaw line
(nasolabial folds)

Smile Lines: Smile lines, or nasolabial folds, are the lines that run vertically from the sides of the nose to the
corners of the upper lip.

Nasolabial Folds: Nasolabial folds, or smile lines, are the lines that run vertically from the sides ofthe nose to
the corners of the upper lip.

Smoker's Lines: Smoker's lines, or vertical lines, are lip wrinkles, vertical wrinkles that form abovethe upper lip
as a result of heredity, sun damage, and smoking.

Static lines: These are deep lines you see when your face is still. Static lines are due to lack of skin elasticity
caused by sun damage, smoking, and genetics.

Viscosity: is a measure of a fluid for example, honey has a higher viscosity than water.
 LIP ANATOMY

1. Cupid’s Bow

1 2. Vermilion Border
2
3 3. Oral Commissure ( Corner of the Mouth )

4. Body of the Lip ( Upper 1/2, Lower 2/3 )

4
 INDICATIONS & CONTRAINDICATIONS
FOR THE TREATMENT

Treatments with fillers based on hyaluronic acid enable the following:

- skin revitalization (improving its hydration, elasticity, firmness and resilience)
- correction of wrinkles (including nasolabial folds, eye area wrinkles, horizontal wrinkles of the forehead)
- facial modeling (eyebrow elevation, nasal bridge correction, change of shape and volume of the lips, cheeks
and chin augmentation)

ABSOLUTE CONTRAINDICATIONS TO THE PROCEDURE:

______________

- Pregnancy and lactation

- Active infection or inflammation of the injection site
- Active herpes
- Purulent lesions
- Allergy to ingredients
- Diseases during treatment
- Immunological diseases – collagenosis type
- Uncompensated diabetes
- Systemic corticosteroids
- Areas injected with permanent filler

RELATIVE CONTRAINDICATIONS TO THE PROCEDURE:

______________

- A person undergoing immunosuppression

- Age under 18 years
- Inclination to keloids
- Non-steroidal anti-inflammatory drugs
- Connective tissue diseases
- Thin, atrophic skin
- Blood thinners
- Granulomatous inflammation
- Recent dermabrasion, chemical peel, laser treatment
 SIDE EFFECTS

POSSIBLE SIDE EFFECTS

___________________

Side effects can appear immediately after the treatment – induced by the injection. They can be caused by the
puncture itself or by the administered product. In order to minimize side effects, treatments with cross-linked
hyaluronic acid should only be carried out by properly trained people, who know in detail the preparation they
work with, injection techniques and depths, as well as indications and anatomical relationships. It is also very
important to conduct a detailed interview with the client and make her aware of possible side effects.

SIDE EFFECTS I:
- hematomas and ecchymosis
- erythema and redness
- swelling
- changes in pigmentation
- thickening, hyper-correction
- papule and pustular changes
- hypersensitivity and allergic changes – does not require allergy tests

These symptoms are most often temporary!

SIDE EFFECTS II:

- infections (rare; compliance with aseptic rules, activation of herpes virus in lip augmentation,
recurrent herpes – recommendations: Heviran 4x0.2, 3 days before and 3 days after the procedure)
- granuloma, hives, cysts
- skin necrosis
- there have been isolated cases of adipose tissue decay after older generation fillers

What are the risks of side effects with HA?

• After the injection some common injection-related reactions may occur, as swelling, redness, pain, itching,
discoloration and tenderness at the implant site. They typically resolve within a few days
• Other types of reactions are very rare, but about one in every 2 000 treated patients have experienced
localized reactions thought to be of a hypersensitivity nature. These have usually consisted of swelling at the
implant site, sometimes affecting the surrounding tissues.
• Redness, tenderness and rarely acne-like formations have also been reported. These reactions have either
started a few days after injection or after a delay of two to four weeks and have generally been described as
mild to moderate and self-limiting, with an averageduration of two weeks.
 TYPES OF DEFECTS TREATED WITH HYALURONIC ACID

Fillers have a variety of applications. The administration of hyaluronic acid is aimed at restoring the symmetry
and the appropriate face volume or uniform tension of the skin. They are used to level existing cosmetic defects
or to enlarge specific facial tissues. In the upper part of the face, HA can be used to reduce wrinkles and to fill
the depressions caused by atrophic scars from acne. They can be used in combination with Botox for the
treatment of deeper wrinkles in the forehead area.
 INJECTION TECHNIQUES

LINEAR THREADING TECHNIQUE

Used most often in the case of deep wrinkles and around the mouth; it consists in inserting the entire needle
into the wrinkles at an angle of 30°, applying the preparation and gently pulling out the needle.
- needle bevel down (injection into the deep layer of the dermis),
- up (injection into the surface layer of dermis)
- flat injection, retrograde injection – almost the entire length of the needle is inserted under the wrinkle being
filled, then withdrawn during the injection. In this way, a continuous deposit is left under the wrinkle, which
allows to very easily obtain an even distribution of the material.

SERIAL PUNCTURE – „MICRODEPOSITS” – TECHNIQUE

Recommended for filling shallow wrinkles and micro-infarctions of the skin. It consists in making a series of
punctures along the entire length of the wrinkle. Small amounts of the injected preparation merge and form a
continuous line. The location of the injection should be massaged. Spot injections are helpful in the case of
correcting very small areas – there are numerous micro-punctures, one next to the other – this technique helps
revitalize some areas of the face and neck, cheeks, décolleté.

FAN TECHNIQUE
Recommended for treatments that increase the volume of larger areas of the skin, it allows to avoid a larger
number of punctures. Injections should be made in such a way that the whole outcome resembles a fan: the
introduction of the needle, administration of the preparation, partial extraction of the needle and turning it at a
different angle. If the correction area is large, we can perform multiple flat-retrograde injections from one
puncture, every time changing the direction of the injection.

CROSS-HATCHING TECHNIQUE – “GRID” – REINFORCING THE SKIN

Recommended in the case of treatments significantly enlarging the volume of selected areas of the skin; it
consists in making parallel up-down and later perpendicular movements so as to draw a square. This technique
is recommended for filling the cheeks. In the case of augmenting the lips to increase their volume, the
preparation must be injected along the lip line, without direct injection into the lip itself. First, correct the central
1/3 of the upper lip and then the corresponding part of the lower lip.

DEPOSIT TECHNIQUE
This technique consists in injecting a small amount of the preparation into the deeper layer of the skin – the
superficial or middle layer of the dermis. It leaves a characteristic bubble that is absorbed and disappears. It is
used in the eye area.
 Serial puncture technique:

Serial threading technique:

Sandwitch technique:

Fan technique: Cross-hatching technique:

How to be sure that you are in the dermis?

If the needle is visible (GRAY COLOUR) through the skin, it means that we are in the epidermis.
If the needle is in the skin and I push it down, a depression or a “groove” after the needle must appear.
 ANESTHESIA

PRINCIPLES OF ANESTHESIA
• Local anesthesia is usually sufficient in the zygomatic region and cheeks
• Lip fillings require conduction anesthesia of infraorbital branch and mental branch
• Chin fillings – mental branch
• Upper part of the nose – lower branch of the trochlear nerve

• Emla cream
Make-up removal > octenisept/skinsept > Snow-white cream application > 30 min under occlusion
Duration of anesthesia: about 10 minutes.

• Mepidont 3%
Dental supplies (can be used even in pregnant women)

ANESTHESIA OF THE LIPS:

Upper lip: 1 ml > At the 3rd tooth, 0.4 ml (0.2 on each side)
At the 1st-2nd tooth, 0.4 ml (0.2 on each side)
0.1 ml to the mucous membrane, to the corners

Lower lip: 0.8 ml > same as above, with the exception of corners.

Supra-orbital nerve

Supratrochlear nerve

Infra-orbital nerve

Mental nerve
 INJECTIONS IN INDIVIDUAL PARTS OF THE FACE

Nasolabial grooves
- HA strong or medium; lift the groove with a linear threading retrograde or fan technique (deep puncture).
- HA medium or light; gently smooth the wrinkles creating “scaffolding" perpendicular to them (superficial
puncture).
- *Preparation with anesthesia – we work from bottom to top.
- *We administer the preparation about 3mm from the mouth in order to fill well and let the muscle push it
through
- *If the client has very strong nasolabial muscles (ca. 15% of people), first you have to block them with Botox;
otherwise the acid will move.

Laugh lines and cheek wrinkles

- HA medium or light – delicate wrinkles – should be filled transversely to them (perpendicular to the curvature,
at an angle).
- Wrinkles should be reduced but not completely removed – excessive filling of this area causes visible
“overhangs” of the filler.

Mouth – contour
- Medium HA, on the contour of the red zone of the lip – short stretches, linear administration
 Mouth – volume – transmucosal application
- We puncture the point between the dry line and wet line (3-4 mm) from the outer edge of the red zone of the lip.
- In the upper lip we apply 2 deposits per side (internal deposit larger, external deposit smaller).
- Two deposits in the lower lip.

Mouth – corners
- HA strong or medium – fan technique just under the corner of the mouth to lift it and support (deep punctures)
- HA medium, perpendicular to wrinkles – superficially (superficial punctures)

Marionette line
- Medium or strong HA
- Punctures along the fold – linear or fan technique to create support in the corner of the mouth
- Alternatively – crosswise to the marionette line to create cheek support and to stretch the wrinkle
- With deep grooves – multi-level punctures
- Correction of the mandibular line – alternatively
 Smoker's wrinkles
- We use max. 0.5 ml of material!
- We use the whitening method (very shallow application of material) in the dermis layer of the mouth.
- Apply wrinkle after wrinkle, millimeter by millimeter.
- In the case of delicate wrinkles – from 1/3 of the height of the upper lip.
- Multi-stage – excessive amount of HA during one session – “doughy” upper lip.
- * If during “smacking” there are hills and dips: first, use Botox because otherwise we will worsen the problem.

Mouth – philtrum
- Emphasizes the upper lip, enlarges the middle zone, reduces the wrinkles of the upper lip.
- We do it if you can see its traces (recommended for younger people).

Mental crease
- HA strong or medium
- Along the crease or transversely to the groove
- In the case of thick skin – a combination of the above techniques
- HA creates additional support preventing the lower lip from drooping.
- *After the administration of large deposit(s), massage; after small deposits, leave for a checkup after 1 week.
- *We do not “whiten” this area because it is too hard.
 PROCEDURE IN THE CASE OF ADMINISTERING EXCESSIVE
AMOUNT OF THE PREPARATION – APPLICATION OF HYALURONIDASE

HYALURONIDASE
_____________

Hyaluronidase is a soluble enzyme that hydrolyzes HA. It is used to dissolve overcorrection with HA fillers, in
order to regain the symmetry of contours. Its effectiveness decreases in proportion to the time during which HA
remains in the skin. Hyaluronidase is a clear liquid which is stored in a refrigerator and diluted in 1ml of saline
to create 150 units. Contraindications to the use of hyaluronidase include people with allergies to insect stings
and thiomersal.

GLOSSARY:
______________

Cheek Volumization: Loss of volume during the aging process often results in hollows in the cheeks caused by
fat loss under the skin. Cheek volumization using facial fillers can restore the cheeks'fullness for a more youthful
appearance.

Elasticity: If the material is elastic, the object will return to its initial shape and size when these forcesare
removed.

Dermal Fillers: Cosmetic facial fillers are often used to fill in fine facial lines and wrinkles, add volumeto the
cheeks, and plump up the lips.

Hyaluronic Acid: Hyaluronic acid (HA) is a substance that occurs naturally in the body. It keeps skin moisturized
and gives it its elasticity.

Lip Contouring: Lip contouring is a lip enhancement technique using injectable fillers to create an improved
vermilion border to better define the lip line and produce plumper, more youthful looking lips.

Lip Enhancement: Thinning lips are a common reality of the aging process. Lip enhancement usingfacial fillers
results in fuller, plumper lips and a more aesthetically pleasing, youthful appearance.

Mouth Lines: Mouth lines, or marionette lines, are vertical wrinkles that form below the comers of themouth,
giving a sad or angry look to the face.

Marionette Lines: Marionette lines, or mouth lines, are vertical wrinkles that form below the cornersof the
mouth, giving a sad or angry look to the face.
 TREATMENT PROCEDURE

• No facials, eyebrow shape or Laser treatments for 2 weeks.

• Conduct a thorough visual consultation, agree treatment and price.
• Check Medical history, Medications, allergies, check contra-indications.
• Inform client of benefits of Botox and all possible complications post treatment.
• Wipe skin with medi-wipe and mark injection sites on clients face with a pen, Fill in thefacial diagram on the
consent form.
• Apply emla.
• Carry out treatment, apply aloe gel and give aftercare advise and make sure the client is aware that the
results ay take up to 2 weeks.
• Book a follow up check up after 2 weeks.

POSSIBLE REACTIONS

• Discomfort or pain at the injection site; headache; and eye problems: double vision, blurred vision, drooping
eyelids, and swelling of your eyelids.
• Rash, red itchy welts, wheezing, dizziness or feeling faint.

GET MEDICAL HELP RIGHT AWAY IF THE CLIENT BECOMES DIZZY OR FAINT.

ANAPHYLAXIS

WHAT IS ANAPHYLAXIS?
___________________

Anaphylaxis is a severe, potentially fatal allergic reaction; also, it is referred to as an Anaphylaxis shock.

Anaphylaxis is your body’s immune system reacting badly to a foreign substance or food (allergen) that it
wrongly perceives as a threat causing an allergic reaction,
Usually within a few minutes of contact with an allergen he whole body may be affected however sometimes the
reaction can take place hours later.
Symptoms of Anaphylaxis include hypotension and narrowing of the airways with associated risks.
When an allergen is present the body produces Histamine. Histamine caused vasodilation and therefore a fall
in blood pressure.
In the lungs, Histamine cause the airways to swell in an attempt to close the door on the allergen.
TREATMENT OF ANAPHYLAXIS
___________________
Administration of an antihistamine is essential to neutralise the effect of the extra histamine produced
by the body’s immune system.

Uniphasic — these come on quickly and symptoms get rapidly worse, but once treated, the symptoms
go and don’t return.

Bi-phasic — these are reactions which may be mild or severe to start with, followed by a period of time
when there are no symptoms, and then increasing symptoms with breathing andblood-pressure
problems.

TREATMENT

Adrenaline auto-injectors are prescribed for those believed to be at risk.

Adrenaline (also known as epinephrine) quickly:

• Constricts bloodvessels
• Relaxes smooth muscles in the Lungs to improve breathing
• Stimulates the heart beat
• Helps to stop swelling around the face and lips
 AMATOMY OF THE FACE

3
4

7
8

EXPRESSION LINES
1. Horizontal forehead lines (Frontalis m.)
2. Frown lines (Glabellar complex m.)
3. Crow's feet (Orbicularis oculi m.)
4. Bunny lines (Nasalis m.)
5. Nasolabial folds (Levator labii superioris alaeque nasi m.)
6. Radial lip lines (Orbicularis oris m.)
7. Marionette lines (Depressor anguli oris m.)
8. Chin line (Mentalis m.)
MUSCLES OF THE FACE
 Yellow - Depressor muscle

Purple - Levator muscle

Cream - Sphincter muscles

EXPRESSION LINES MUSCLES ACTION

 Temporal branches

Zygomatic branches
Buccal branches

Innervation of the orbicularis oculi meuscle Homogeneous distribution of the motor

which receives nerve ending from the buccal, zones of the orbicularis oculi muscle,
zygomatic and lower temporal branches. as described by Happak.

Angular nerve

Zygomatic branches Innervation of the procerus muscle, the motor

nerve ending penetrates into the posterior side of
the muscle in an area of about 5mm situated in
Buccal branches
the midpoint between the lateral half of the
intercanthal line in the lower third of the region
included between the line tangential to the
superior orbital margin and the intercanthal line.
The angular nerve receives nerve fibres from the
buccal and zygomatic branches.
 CUTANEOUS INNERVATION FACIAL NERVE DISTRIBUTION

Supraorbital nerve

Supratrochlear nerve
Tempral branches
Zygomaticofacial nerve
Zygomatic branches
Infraorbital nerve
Nasal nerve
Buccal nerve

Buccal branches

Marginal mandibular
branch
Mental nerve

Cervical branch

VASCULAR SUPPLY OF THE FACE

Supratrochlear artery and vein

Supraorbital artery and vein

Superficial temporal artery and vein

Angular artery and vein

Retromandibular vein
External carotid artery

Infraorbital artery and vein

Lateral nasal artery

Labial arteries
Facial vein
Facial artery
 www.theaestheticbox.co.uk
[email protected]

Bletchley Clinic,
54 Queensway,
MK2 2SA, Bletchley

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