Neurotoxins and Fillers in Facial Esthetic Surgery

This book offers a detailed, practical guide to incorporating minimally invasive cosmetic surgery into dental practice.  Chapters thoroughly examine all aspects of using these materials in practice, and present step-by-step techniques for injecting and placing neurotoxins and fillers, with specific recommendations for product selection and in-depth information on case management.  Anatomical drawings and clinical photographs depict the procedures and concepts described. 

From patient evaluation, treatment planning, and product selection to techniques, managing complications, and marketing the service, Neurotoxins and Fillers in Facial Esthetic Surgery provides a complete resource for using these techniques in practice.  Coverage encompasses facial anatomy, neurotoxins, cosmetic fillers, hyaluronic acid dermal fillers, Radiesse™ calcium hydroxylapatite injectable filler, pearls and pitfalls, and how to build your practice. 

• Offers a complete but easy-to-use-reference on all aspects of how to set up a minimally invasive cosmetic facial surgery service within an oral and maxillofacial surgery practice
• Surveys the range of products available in detail from an objective viewpoint
• Presents how-to techniques for injecting and placing neurotoxins and fillers 

Neurotoxins and Fillers in Facial Esthetic Surgery is an essential reference for any oral and maxillofacial surgeon or general dentist wishing to add minimally invasive cosmetic surgery to their repertoire.

The Editors

Bradford M. Towne, DMD, is a board-certified oral and maxillofacial surgeon and is retired as a Clinical Associate Professor in the Department of Oral and Maxillofacial Surgery at the Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.

Pushkar Mehra, BDS, DMD, MS, FACS, is Professor and Chair in the Department of Oral and Maxillofacial Surgery and Associate Dean for Hospital Affairs, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.

List of Contributors xi

Foreword xiii

About the Companion Website xv

1 Facial Anatomy and Patient Evaluation 1
Timothy Osborn and Bradford M. Towne

1.1 Facial Anatomy 1

1.2 Anatomy of Facial Skin 1

1.3 Anatomy of the Superficial Fat Compartments 2

1.4 Anatomy of the Facial Fasciae 3

1.5 Anatomy of the Facial Mimetic Muscles 5

1.6 Anatomy of the Deep Facial Fat Compartments 7

1.7 Anatomy of the Ligamentous Structures (Retaining Ligaments) of the Face 8

1.8 The Blood Supply of the Face 10

1.9 The Aging Face 10

1.10 Patient Selection, Assessment, Records 13

1.11 Patient Selection and Assessment 14

1.12 Treatment Sequencing 15

References

2 Neurotoxins: The Cosmetic Use of Botulinum Toxin A 19
Jon D. Perenack and Shelly Williamson‐Esnard

2.1 Botulinum Neurotoxins Introduction 19

2.2 Botulinum Toxins Physiology and Characteristics 20

2.3 Manufacturing Process 20

2.4 Clinical Usage 24

2.4.1 Age of Patient Treated 25

2.4.2 Storage and Preparation of BoNTA 26

2.4.3 Patient Preparation and General Injection Tips 28

2.4.4 Treatment Recommendations for Specific Areas 30

2.4.4.1 Glabella 30

2.4.4.2 Forehead 32

2.4.4.3 Crow’s Feet – Lateral Orbital Lines 32

2.4.4.4 Indirect Browlift 35

2.4.4.5 Correcting Brow Asymmetry 35

2.4.4.6 Other Midface Techniques: Bunny Lines 36

2.4.4.7 Perioral Modifications with BoNTA 36

2.4.4.8 Treatment of Platysmal Bands 39

2.5 Treating Facial Asymmetries Secondary to Muscle Paralysis 41

2.6 Post‐ treatment Recommendations and Complications 41

2.7 Conclusion 42

References 43

3 Cosmetic Fillers 47
Alexandra Radu and Faisal A. Quereshy

3.1 History of Cosmetic Fillers 47

3.1.1 Emergence of Autologous Fillers 48

3.1.2 Emergence of Non‐autologous Fillers 48

3.1.2.1 Silicones 49

3.1.2.2 Bovine Collagen 49

3.1.2.3 Porcine Collagen 49

3.1.2.4 Polymethylmethacrylate (PMMA) 49

3.1.2.5 Hyaluronic Acid 50

3.1.2.6 Dextran Beads in Hyaluronic Acid 50

3.1.2.7 Poly‐l‐lactic Acid 50

3.1.2.8 Calcium Hydroxylapatite 50

3.1.2.9 Polyvinyl Microspheres Suspended in Polyacrylamide 51

3.1.2.10 Polytetrafluoroethylene (PTFE) 51

3.1.2.11 Polyoxyethylene and Polyoxypropylene 51

3.2 Classification 51

3.2.1 Biodegradable Facial Fillers 51

3.2.2 Autologous and Allogeneic Facial Fillers 51

3.2.3 Xenograft Facial Fillers 53

3.2.4 Synthetic Facial Fillers 53

3.2.5 Nonbiodegradable Facial Fillers 53

3.3 Ease of Use 53

3.4 Benefits 55

3.5 Complications 58

References 61

4 Hyaluronic Acid Dermal Fillers 63
Tirbod Fattahi and Salam Salman

4.1 Introduction 63

4.2 Hyaluronic Acid 63

4.3 Available Products 64

4.4 Clinical Indications 64

4.5 Injection Techniques 64

4.6 Selection Process 65

4.7 Reversibility of HA Fillers 65

4.8 Clinical Scenarios 66

4.8.1 Nasolabial Grooves 66

4.8.2 Lips 66

4.8.3 Tear Troughs 66

4.8.4 Glabella 67

4.9 Post‐ Injection Instructions 68

4.10 Longevity of HA Fillers 68

4.11 Conclusion 69

References 69

5 Radiesse™ Calcium Hydroxylapatite Injectable Filler 71
Nikita Gupta, Onir L. Spiegel, and Jeffrey H. Spiegel

5.1 Treatment in Practice 72

References 74

6 Pearls and Pitfalls of Neurotoxins and Facial Fillers 75
Raffi Der Sarkissian

6.1 Pearls and Pitfalls in Neurotoxin Use 75

6.2 Neurotoxin Preparation and Storage 75

6.3 Choice of Syringes and Needles 76

6.4 Basic Injection Principles 77

6.5 Specific Injection Pearls Based on Injection Site 78

6.5.1 Glabellar Techniques 78

6.5.2 Forehead Techniques 80

6.5.3 Periorbital Techniques 81

6.5.4 Treatment of Bunny Lines 83

6.5.5 Depressor Anguli Oris Techniques 83

6.5.6 Perioral Techniques 83

6.5.7 Levator Labii Superioris alaeque Nasi 84

6.5.8 Techniques for Chin Dimpling 85

6.5.9 Treatment of Platysmal Bands 85

6.5.10 Treatment for Masseter Hypertrophy 86

6.6 Neurotoxin Complications 87

6.7 Cosmetic Facial Fillers: Pearls and Pitfalls 88

6.8 Technical Pearls 91

6.9 Needles vs. Cannulas 92

6.10 Specific Injection Pearls 92

6.10.1 Fine Lines 92

6.10.2 Melolabial Groove 92

6.10.3 Labiomandibular Groove 93

6.10.4 Pre Jowl Sulcus 93

6.10.5 Labiomental Groove 93

6.10.6 Midface Volumization 94

6.10.7 Temporal Hollows 96

6.10.8 Lips 97

6.10.9 Nasojugal Groove 97

6.11 Complications of Facial Fillers 99

6.11.1 Bruising 99

6.11.2 Nodules 99

6.11.3 Overcorrection 99

6.11.4 Tyndall Effect 100

6.11.5 Calcium Hydroxylapatite 100

6.11.6 Sculptra 100

6.11.7 Granuloma Formation 100

6.11.8 Vascular Compromise 100

References 102

7 Building Your Practice 103
Jay R. Levine

7.1 Internet Marketing: What’s in it for you? 103

7.2 Promoting Your Practice: Formulating a Strategy 103

7.3 Website Design Companies 104

7.4 Building Your Brand 104

7.5 Print Marketing 104

7.6 Website Design: Choosing a Designer 104

7.6.1 Other Items to Consider when Choosing a Website Designer 105

7.6.2 Designing Your Website 106

7.6.2.1 Connect with the User 106

7.6.2.2 Outside Perspective 106

7.6.2.3 Accuracy 106

7.6.2.4 Doctor Bios – How Important Are They? 106

7.6.2.5 Accessibility 106

7.6.2.6 Additional Features 107

7.6.3 SEO: More on Search Engines 107

7.6.3.1 Five Basic SEO Steps you can Take Yourself 107

7.6.3.2 Blogging 108

7.6.3.3 SEO: When to Call in the Experts 108

7.6.4 Online Ads: PPC with Google AdWords 108

7.6.4.1 Managing AdWords 108

7.6.5 Social Media: Getting Started 108

7.6.5.1 The Three Es of Social Marketing 108

7.6.5.2 How to Gain Followers 109

7.6.5.3 Facebook 109

7.6.5.4 Instagram 109

7.6.5.5 Twitter 109

7.6.5.6 YouTube 109

7.6.5.7 Pinterest 110

7.6.5.8 LinkedIn 110

7.7 Protecting Your Practice Online 110

7.8 Internet Marketing: Measuring Your Progress 110

7.9 Marketing Is Communication 110

References 111

Index 113

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