ONLINE BASIC FACE FILLING

COURSE
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Your online facial filler course starts here, pay attention and write
down all the important points.
Mainly anesthetic techniques and areas where we can work with
Hyaruronic Acid.
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Historic

Facial fillers:

Until 1990
• Silicone: numerous adverse events
• Bovine collagen: short duration and need for sensitivity tests

90's
• PMMA – adverse events
• Hyaluronic Acid of animal origin (fish eye and rooster comb) - low duration and low filling
capacity

After 1996
• Hyaluronic Acid of NON-animal and cross-linked origin: does not require testing, greater
durability, higher level of safety and efficacy.

Not moment...
• High technology in facial fillers;
• Hyaluronic acid with longer useful life in tissues;

Greater predictability of results.

 Classification 3

Water BDDE

solvent Reticulante

GEL

Correos VISCOUS LIQUID GEL

BDDE: crosslinking agent

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FACIAL FILLERS

Types of fillers:

Hyaluronic Acid (HA) (Biodegrade) • Collagen

Semi-permanent: Poly-L-Lactic Acid (PLLA) (slow degradation)

• Calcium Hydroxypatite

Non-absorbable: polyacrylamide (non-biodegradable) •

Polymethylmethacrylate (PMMA)

Hyaluronic acid:
High molar mass linear polysaccharide consisting of polyanionic
disaccharide units of D-glucuronic acid and N-acetylglucosamine.

Present in all vertebrate tissues, with the highest concentrations observed

in loose connective tissue and the lowest concentrations in blood.

The skin constitutes the body's main reservoir of hyaluronic acid, with
more than 50% of the total present in the extracellular matrix that
constitutes the dermis. Mainly synthesized by fibroblasts and
keratinocytes.
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Anatomy
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APPLICATION PLANS
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Hyaluronic acid

Initial techniques:
• Lips
• Nasolabial folds - “Chinese mustache”
• Periorbicular lines – “barcode”
• “Puppet Line”

Advanced techniques:
• Rhinomodeling
• Malar filling
• Filling dark circles
• Jaw filling
• Mental highlight
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HA INJECTION TECHNIQUES

Bolus: Injected into a single point once

small amount of product (usually
supraperiosteal).

Linear retrograde: The product is

injected into a single point in a linear
fashion while the needle is removed
from the skin. Locks: Transverse injection
points, generally associated
with the linear retroinjection
Fan: In a single injection point and technique.
with
The needle placed on the shaft
creates several linear tunnels in a fan-
like pattern.
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NEEDLE, CANNULA OR ASSOCIATION

Needle x Cannulas
The cannula has a blunt tip (rounded and blunt) and the needle has a
pointed tip.
The choice will depend on factors such as:

• Region to fill in
• Filling depth
• Professional skill
• Volume de material

Determinants of injection technique:

• Viscosity of the material
• Anatomical plane (level) to be
implemented
• Volume of material implanted
• Region to be treated
• Action area
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FILLING TECHNIQUES

Lip filler:

• Cupid's bow
• Contours
• Lower tubercles
• Upper tubers
• Filters
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Filling Techniques

Nasolabial fold filling:

• Retroinjections with cannula or
needle
• Combined cannula and needle
technique
• Locks

Filling in the “puppet line” region:

• Evaluate the association of the technique with the application
of Botulinum Toxin (Depressor Angle of the Mouth Muscle)

• Assess dental conditions; and check the vertical dimension.

• Needle or cannula technique

 Filling techniques
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“Barcode” filling (periorbital wrinkles):

• Re-injections into deeper wrinkles;

• Evaluate the association of HA and Botulinum Toxin
in the region.
• Question the patient's habits and lifestyle.
• Needle technique

Anesthetic Techniques:
For filling: upper and lower lip, nasolabial fold (Chinese mustache),
“barcode” and “puppet line”
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NERVE BLOCK

Infraorbital nerve: Mental nerve:

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CONTRAINDICATIONS

Hyaluronic acid:
• Pregnancy
• Breast-feeding
• Coagulation disorders
• Inflammatory process in the region.

• History of collagen diseases.
• History of hypersensitivity to birds and bacteria.
• Hypersensitivity to the product
• Uncontrolled autoimmune diseases
• Presence of permanent fillers at the application
site.
• Pediatric use
Attention!!!
• Unrealistic patient expectations
•Decompensated systemic diseases
• Previous plastic surgeries
• anticoagulant therapy
• Local inflammation (pimples)
• Permanent fillings (PMMA)
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CLINICAL GUIDE

Request daily photos and patient comments during the first few days.

Turn back:
• Return for evaluation in 7 days
• Touch up as needed after 30 days

There is no risk-free filling, therefore all patients must be informed of

the possibility of adverse reactions.

Hialuronidase:
• Enzyme obtained from bovine testicles; It works by reversibly depolymerizing the
HA existing around the connective tissue cells, promoting the degradation of the
injected HA, in cases of complications and/or adverse reactions, as a form of
treatment, with consequent improvement.
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COMPLETE SAFELY

• Use reversible fillers (hyaluronic acid)

• Proper technique: Always vacuum!!!

• Use microcannulas when possible

• Retrograde application, keeping the needle in constant movement

• Inject in small increments

• Apply with low pressure: injections that require high pressure

mean danger and/or an inappropriate location.

• Use extreme caution when injecting into areas of previous

trauma/scarring

• Be aware of relevant anatomy, delimited by danger zones

• Have an emergency kit available (vasodilator, aspirin,

hyaluronidase)
 CLINICAL PRACTICE GUIDE 17

• Sign anamnesis form

• Sign the Free and Informed Consent Form

• Extra and intraoral assessment of the patient

• To clarify doubts

• Pre-filled medications

• Initial photography

• Antisepsis

• Anesthesia

• Area delimitation

• Fill-in application (with supervision of a teacher)

• Final photography

• Clinical report: regions applied, quantity, filler used

(batch and manufacturing) - poster