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ESSENTIALS OF NEUROMODULATION
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ESSENTIALS OF NEUROMODULATION
A Comprehensive Guide for Aesthetic Practitioners
TARA DELLE CHIAIE MSN, FNP-BC, APRN
Essentials in Neuromodulation; A comprehensive guide for aesthetic practitioners Copyright @2021
https://t.me/medicina_free
DCCM
All rights reserved.No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author and publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, contact Tara Delle Chiaie and Elsevier.
Dedication
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This book is dedicated to my three boys (Quinn, Gavin, and Tristan). These three little men have supported me all along the way while I poured my heart and soul into creating this book and the growth of my practice. I went back to college for my Master’s degree while on maternity leave with my third son, Tristan. The importance of education has been at the heart of our household from the time they were little. As they grew, their excitement and pride in me, their mom, fueled my continued growth in the industry. I wanted to be an example, a role model for the boys to set their goals high and continually strive for more. Even if it is not in esthetics, I wanted them to see the value in education, the devotion it takes to create something you are proud of and, what it means to influence others positively. They believed in my mission to make the esthetic industry a better place for the providers and the patients. I hope that they have seen the difference between a career versus a job with the passion invested in my craft. May they find a career that they are wholeheartedly dedicated to. I was told many years ago; that if you follow your heart, the money will follow, and you will never work a day in your life. This is so cliche as an adult, but, it resonated with me in my youth and has become a powerful truth in my adult years. It is easy to tell the dif­ference between an educator and a salesperson. The educator believes in the task and can back it up with proof.
Boys, my message to you is; to be the leader, the educator, and the inno­vator. Believe in yourself and your dreams. The only thing standing in your way of success is a lack of effort. Get out there and show the world you are a shark. The shark doesn’t wake up on Monday, complaining it’s a Monday. Better yet, the shark is up early and biting stuff reminding everyone he is the shark. When someone tells you no, find a way, don’t settle, don’t let your dreams die because someone else does not share your vision. Believe in yourself and your future, and go get your dreams and desires.
I love you three,
Love Mom
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Contents
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About the author xi Acknowledgments xiii
Disclaimer xv
1. Introduction 1
2. Statistics in esthetics 11
3. Understanding esthetic terminology 13
Understanding the interchangeable terms 13
4. What is botulinum toxin 17
Understanding the nervous system 18
Mechanism of action of BoNT-A 20 Step by step on how BoNT-A work 20
Nerve terminal with release of acetylcholine 22 Review of the variety of BoNT-As commercially available in the United States 23 Cosmetic and therapeutic uses of BoNT-A 26
References 27 Further reading 27
5. History of neuromodulators 29
History of onabotulinumtoxinA (Botox), incobotulinumtoxinA (Xeomin),
abobotulinumtoxinA (Dysport), prabotulinumtoxinA-xvfs (Jeuveau) 30 Reference 31 Further reading 32
6. Safety of neuromodulators 33
Caution with the silicone stoppers 34
Contraindications with the use of ALL neuromodulators 35 Contraindications for the injector to consider 36
Drug to drug interactions 41 References 43
vii
viii
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Contents
7. Common myths about neuromodulators 45
Common myths 45 FAQs from the patient 45
8. Anatomy 49
Beginning to understand facial anatomy 49 Soft tissue 50
Hypodermis 53 Fat pads 56
Muscles of the face 58 Circumorbital group 61
Nasal muscle group 61 Buccolabial muscle group 63 Compound sphincter muscle group 65
Muscles by facial groups and areas 65 Skeletal structure 66
Further reading 68
9. The esthetics of aging 69
The aging face 69
Aging muscles 77 Patient selection 78
Patient assessment 79 Physical assessment 82
Assessment of the upper face 83 Static versus dynamic lines 84
References 95
10. Injection preparation 97
Reconstitution 97
Example of calculation for reconstitution of Botox 100 Examples of calculation for reconstitution of Xeomin 102
Examples of calculation for reconstitution of Jeuveau 103 Examples of calculation for reconstitution of Dysport 103
Storage and handling 104 Novice areas and advanced areas for neuromodulation 104 Novice (N) areas and advanced areas (A) 105
References 105 Further reading 105
Contents
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11. Neuromodulation injection technique procedural steps 107
Neuromodulation for frown linesGlabellar complex injections 108 Neuromodulation for the frontalis-forehead wrinkles 129
Neuromodulation technique in lateral canthal lines aka crows feet 149 Neuromodulation technique in eyebrow lift 162 Neuromodulation technique in lower eyelid wrinkles 172
Neuromodulation technique of the bunny lines aka nasalis lines 180 Neuromodulation technique of peri-oral rhytids aka smokers lines 187
Neuromodulation technique of gingival show AKA gummy smile 196 Neuromodulation technique of marionette lines 207
Neuromodulation technique of the chin 215 Neuromodulation technique of platysmal bands 223
Hyperhidrosis injection technique 231
12. Complications 235
Potential complications 235 Toxin spread 236
Complications 238 Lid ptosis 239 Cosmetic application dosing 239
Glabellar region 239 Frontalis muscle 240
Understanding ptosis 240 Lateral canthal lines 240
References 244 Further reading 244
ix
13. Return on investment (ROI) 245
14. Marketing in esthetics 247
Marketing 247 Examples of pre and post neuromodulation emails 248 Relationships in business 251
15. Top 10 list for success in neuromodulation 253
Top 10 list for success 253
Reference 260