PRE-READING COURSE MATERIAL ADVANCED BOTOX AND DERMAL FILLERS - Module 3 - Acquisition Aesthetics
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PRE- READING COURSE MATERIAL
ADVANCED BOTOX® AND
DERMAL FILLERS
Module 3
Dear Acquisition Aesthetics delegate,
These pre-reading documents form the lectures you will attend on the day of training.
As a CPD certified course based on theoretical knowledge, we ask that you review all
the material prior to the course date.
Please feel free to print the pre-reading modules to annotate on the day.
You will be provided with an abbreviated practical guide for your review on the
training day.
We look forward to seeing you soon and happy reading!
Yours sincerely,
Acquisition Aesthetics
2
Dermal Fillers:
Advanced
Principles and
Practice
3
Objectives
Historical background
Basic sciences and mechanism of action
Refresher of foundation
principles and techniques
Advanced techniques
Lip augmentation Temporal hollows
Cheek augmentation Perioral lines
Jaw contouring Hand rejuvenation
The market
4
Historical
background
5
Historical background
• The practice of injectable soft tissue
augmentation dates back to the late
1800s
• Paraffin was the first known injectable
agent used
• Silicone based agents were later trialed
6
Historical background
The popularity of these
early agents was short lived
due to serious
complications such as
systemic migration,
embolisation and
granuloma formation
They were subsequently
banned by the Food and
Drug Administration (FDA)
7
Historical background
• Bovine collagens were granted FDA approval in 1981
• In 2003, human derived collagens emerged (reduced rates of
hypersensitivity / allergic response)
• Collagen based fillers were considered to lack longevity
• Introduction of Hyaluronic acid (HA) fillers
• HA fillers provide the desired longevity and necessary safety profile.
Creates the same degree of volume enhancement with less product
8
Basic sciences
and mechanism
of action
9
Basic sciences and mechanism of action
• Hyaluronic acid (HA) dermal fillers
currently dominate the aesthetic
industry
• HA is a naturally occurring component
of human soft tissue
• Minimal risk of hypersensitivity and
adverse reactions
• HA is stabilised in a carrier gel
although ‘cross-linking’ technology
• The aesthetic result is largely
determined by product biomechanical
profile
• Most modern DF preparations contain
Lidocaine(topical LA still
recommended)
10Basic sciences and mechanism of action
The biomechanical profile of HA fillers is
determined by:
• Hyaluronic acid concentration
• Cross - linking technology
• Hydration
• Viscosity
• Gel properties
• Longevity
Practitioners should appreciate the biomechanical interplay between HA fillers and the
soft tissues which determines the aesthetic result. This will help guide appropriate
choice of product.
11Basic sciences and mechanism of action
Hyaluronic acid fillers’ longevity
varies and is commonly quoted
around 9 - 18 months
Newer product ranges are said to
last up to 24 months
Longevity is mainly determined by:
• The degree of cross - linking
• Depth of placement
• Metabolism
• Exposure to extreme
temperatures
12Biomechanics of the Restylane range
• The world’s first non-animal stabilised hyaluronic acid (HA) filler
• Crosslinker BDDE (1,4 butanediol-diglycidyl-ether) converts into gel form
• 2 unique and complementary technologies: OBT + NASHA
• 20mg/ml Hyaluronic acid
OBT NASHA
‘Optimal Balance Technology’ ‘Non-animal stabilised hyaluronic acid’
Variations in particle size and cross-linking creates gels Uniform natural entanglement of HA strands with
of different textures variations in particle size to create a variety of gel textures
13Biomechanics of the Restylane range
OBT NASHA
‘Optimal Balance Technology’ ‘Non-animal stabilised hyaluronic acid’
Variations in particle size and cross-linking creates gels Uniform cross-linking technology with variations in
of different textures particle size to create a variety of gel textures
Lower G’
Higher xSTRAIN
Softer and flexible gels for contouring and
volumisation of the mid-face / lower third
Higher G’
Lower xSTRAIN
Firmer gels with greater lifting capacity
where targeted tissue integration is
desired
14Basic sciences and mechanism of action
The aesthetic benefits of dermal fillers:
• Volume enhancement
• Wrinkle reduction
• Recontour / sculpt
• Rehydrate
• Restore and refine
• Smoothen / soften surface appearance and
texture
The nature of dermal fillers also allows for
incremental administration, giving the
client a sense of control and security
The effects (although long lasting) are still
temporary at 6 and 18 months
15Basic sciences and mechanism of action
These products provide instant
enhancement and the changes can be as
subtle or dramatic as the client desires
A – Nasolabial folds F – Deep glabellar lines
B – Marionette lines G – Temporal hollows
C – Vertical lip lines H – Cheek augmentation
D – Chin wrinkles I – Orbital rim
E – Lip augmentation J – Nose augmentation
16Refresher of
foundation principles
and techniques
17Foundation refresher
Injection technique:
The key to dermal fillers is to deposit the material at the correct depth and in the
correct volume.
• Too deep - the client will be left with
unnoticeable and disappointing
results
• Too superficial - you may create
undesirable lumps, discolouration or
granuloma formation
• By altering the insertion angulation
of your needle you can adjust the
depth of administration
Aspirate prior to injecting any filler
18Foundation refresher
Techniques of delivery vary depending on the indication, site, product and
experience and preference of the injector.
Techniques include:
• Linear threading • Cross - hatching
• Serial puncture • Depot
• Fanning
Linear threading Serial puncture Fanning Cross - hatching
19Foundation refresher
Use of the microcannula:
Blunt-tipped flexible needles that come in a range of lengths and gauges
✓ Flexible
✓ Less bruising /swelling
✓ Minimally traumatic
✓ Reduced risk of vascular occlusion
✓ Reduced downtime
✓ Wider area covered
✓ Reduced risk of infection
✓ More comfortable
✓ Stimulates neocollagenesis
But less accuracy / precision + limitations on injection technique
20Advanced
techniques
21Advanced techniques
Lip augmentation
Treatment objectives:
• Natural fullness • Smooth and soft appearance
• Well - defined vermilion border and cupids bow • Aesthetic balance between upper
and lower lips 1:1.6
• Good projection
22Advanced techniques
Lip augmentation – Technical considerations
• Focus volume injections to the
middle 2/3rds upper lip and middle
1/3rd lower lip
• Keep track of amount of filler used
• Aspirate before you inject
• Treating the vermillion border
• Volume ratios
• Bruising
• Corners of cupids bow should
remain prominent and defined and
in line with the philtrum columns
• Massage the lips
23Advanced techniques
Lip augmentation – Techniques
• Volume enhancement:
• Linear threading wet/dry border
• Boluses (tubercles)
• Fanning
• Definition:
• Linear threading along vermillion
border
• Microboluses at peak of cupid’s
bow
• Philtral columns
• Oral commissures
24Advanced techniques - Vectoring
Volume enhancement from the vermilion border
• An alternative method of volume
enhancement
• Serial injections from the vermilion
border into the body of the lips with the
linear threading technique
• Focus volume enhancement to middle
2/3rd upper lip and middle 1/3rd lower
lip
• May supplement with other techniques
25Advanced techniques
Temporal Hollows- Marking up; landmarks
• Ageing causes a loss of volume in the upper/
mid-face which can create the appearance of
deep temporal hollows
• Dermal fillers can be used to restore youthful
fullness to this zone
Landmarks:
• Palpate (ZF) suture
• Measure approx. 1cm up the crest and
temporally 1cm following curve of orbital rim
• This should define your injection site at the
superior margin of the temporal hollow
26Advanced techniques
Temporal Hollows- Technique
• Deep supraperiosteal bolus beneath
temporalis (up to 1ml)
• High viscosity product
• Fibrous septae will stop product tracking
anteriorly beyond the orbital margin
• Use a finger to prevent excessive
retrograde flow of product
• Inject slowly, allowing the the product to
fill the hollow directly beneath the
injection site
Chewing may be uncomfortable in the 3-7 days
following treatment
27Advanced techniques
Cheek augmentation - Marking up; landmarks
• Mark the lateral canthus, tragus and ipsilateral oral
commissure
• Join these points to form a triangle
• Within this triangle draw an oval
• Divide this oval into two hemispheres
• Split the hemispheres into 3 vertical equal sections-
the three upper sections represent the 3 main
injection sites for cheek augmentation.
• From medial to lateral, these are the
anteromedial cheek, zygomatic eminence and
zygomatic arch
28Advanced techniques
Cheek augmentation - Technique
• The initial injections are deep and product is deposited in boluses (0.1 - 0.3mls)
just superficial to the periosteum to create an anchoring effect.
• High viscosity product.
• Additional injections can be given into the lower hemisphere segments and
towards the hairline to the upper outer aspect of the treatment zone
Before After
29Advanced techniques
Jaw contouring / chin augmentation
The process of ageing can lead to sagging of the lower face including the jawline and
chin.
Dermal fillers can be used to return definition to this area to achieve a more youthful
appearance
Before After
30Advanced techniques
Jaw contouring – needle technique
• A deep bolus can be injected at
the angle of the mandible
• Serial boluses can then be
injected along the length of the
jawline and massaged to create
smooth volume enhancement.
NB: facial artery!
• +/- deep bolus at the pre-jowl
sulcus. NB: mental nerve!
31Advanced techniques
Jaw contouring- microcannula technique
• Alternatively, a microcannula can
be used to restore definition to
this area
• Fanning technique is applied at
the angle of the mandible
• Linear threading technique used
along the length of the jawline
• Alternatively, introduce
microcannula 1/3rd distance from
chin-angle of mandible
32Advanced techniques
Perioral lines
• Retrograde threading / serial
puncture
• Exaggerate lines by pursing lips
• Low viscosity product
• May treat lines directly or deposit
linear threads traversing multiple
lines
• Massage to achieve even
distribution
33Advanced techniques
Pre-jowl sulcus / corners of the mouth
• Dark hollows can appear beneath
the corners of the mouth through
ageing process
• Fill with a mid-viscosity product
using needle / cannula
• Linear threading / fanning
• Down-turned corners of the mouth
Tx::
̶ Small boluses beneath oral
commissures
̶ ‘Wrist-twist technique’
34The market
35The market
Galderma - Restylane
36The market
37Dermal fillers - The market
Key manufacturers and products
38Dermal fillers – what to use and where
39Dermal fillers – what to use and where
40Dermal fillers – what to use and where
41Dermal fillers – what to use and where
42Dermal fillers – what to use and where
43Dermal fillers – what to use and where
44Lecture overview
Historical background
Basic sciences and mechanism of action
Refresher of foundation
principles and techniques
Advanced techniques
Lip augmentation Temporal hollows
Cheek augmentation Perioral lines
Jaw contouring Hand rejuvenation
The market
45You can also read
